急诊老年严重创伤患者院内低体温风险预测模型的构建及验证

doi:10.3969/j.issn.1003-9198.2026.03.008

摘要/Abstract

摘要： 目的探讨急诊老年严重创伤患者院内低体温的发生情况及其危险因素,构建预测模型并进行验证。方法回顾性分析2020年9月至2024年9月海军军医大学第二附属医院急诊收治的老年严重创伤患者524例,按照7∶3比例分为建模集和验证集,根据患者是否发生低体温,将建模集和验证集各分为低体温组和非低体温组,采用多因素logistic回归分析筛选危险因素,据此构建急诊老年严重创伤患者院内低体温风险预测列线图模型,并使用ROC曲线、校准曲线和临床决策曲线分析(DCA)验证模型的区分度、校准度和临床应用价值。结果建模集367例患者中65例发生低体温,发生率为17.71%(65/367)。多因素logistic回归分析结果显示,到院核心体温(CBT)、创伤严重程度评分(ISS评分)、Hb、纤维蛋白原(FIB)及乳酸(Lac)水平是急诊老年严重创伤患者院内发生低体温的独立危险因素(P<0.05)。据此构建的预测模型在建模集和验证集的AUC分别为0.874(95%CI:0.782～0.945)和0.863(95%CI:0.721～0.914),区分度良好;校准曲线显示,在建模集和验证集中,急诊老年严重创伤患者院内低体温的预测概率与实际发生率接近,校准度良好;DCA显示模型具备较高净获益,预测价值良好。结论 CBT、ISS评分、Hb、FIB及Lac是急诊老年严重创伤患者院内低体温的危险因素,据此所构建的预测模型具有较高的区分度和临床应用价值。

关键词: 急诊, 严重创伤, 老年人, 院内低体温, 预测模型

Abstract: Objective To investigate the incidence and risk factors of in-hospital hypothermia in the elderly patients with severe trauma at Emergency Department, and to develop and validate a prediction model. Methods A retrospective analysis was conducted on 524 elderly patients with severe trauma admitted to Emergency Department of the Second Affiliated Hospital of Naval Medical University from September 2020 to September 2024. Patients were randomly divided into a modeling cohort and a validation cohort at a ratio of 7∶3. According to the occurrence of hypothermia, each cohort was further stratified into a hypothermia group and a non-hypothermia group. After univariate analysis of candidate variables, multivariate logistic regression was performed to identify independent risk factors. A nomogram-based prediction model for in-hospital hypothermia in the elderly patients with severe trauma was constructed accordingly. The model’s discrimination, calibration, and clinical applicability were evaluated by the receiver operating characteristic(ROC) curve, calibration curve, and decision curve analysis (DCA), respectively. Results Of the 367 patients in the modeling cohort, 65 developed hypothermia, with an incidence rate of 17.71% (65/367). Multivariate logistic regression identified core body temperature (CBT) on arrival, injury severity score (ISS), hemoglobin (Hb), fibrinogen (FIB), and lactate (Lac) were independent risk factors for in-hospital hypothermia (P<0.05). The area under the ROC curve (AUC) of the prediction model was 0.874(95%CI:0.782-0.945)in the modeling cohort and 0.863(95%CI: 0.721-0.914) in the validation cohort, which indicated good discrimination. Calibration curves showed close agreement between the predicted probabilities and actual occurrence of hypothermia in both datasets, demonstrating good calibration. DCA indicated substantial net benefit, supporting favorable clinical utility. Conclusions CBT, ISS, Hb, FIB, and Lac are independent risk factors for in-hospital hypothermia in the elderly patients with severe trauma at Emergency Department. The prediction model constructed based on these factors shows high discrimination and good clinical application value.

Key words: emergency department, severe trauma, aged, in-hospital hypothermia, prediction model

中图分类号:

R 605.97

徐加萍, 何超, 林小凤, 张丽霞, 朱子贤, 孔丽. 急诊老年严重创伤患者院内低体温风险预测模型的构建及验证[J]. 实用老年医学, 2026, 40(3): 261-266.

XU Jiaping, HE Chao, LIN Xiaofeng, ZHANG Lixia, ZHU Zixian, KONG Li. Construction and validation of an in-hospital hypothermia risk prediction model for elderly patients with severe trauma in Emergency Department[J]. Practical Geriatrics, 2026, 40(3): 261-266.

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