摘要
目的:儿童扁桃体术后出血是一种严重且可能危及生命的并发症,本研究旨在通过一项全国多中心回顾性研究来构建儿童扁桃体术后出血的风险预警模型,为儿童扁桃体术后分层管理提供依据。方法:通过对2022年1月15日-2023年5月15日从不同省份的15个研究中心接受全身麻醉下行扁桃体切除术的8854例患儿进行分层抽样后得到,本研究样本量2724例,其中男1096例,女1628例。根据术后患儿有无出血分为出血组与未出血组,采用随机森林算法构建风险预警模型,通过不断探寻最优化模型,提高预测儿童扁桃体术后出血率的准确性,并通过十折交叉验证模型的预测效能。结果:2724例患儿中有117例扁桃体术后出血,出血率为4.30%。采用随机森林算法针对训练集构建的模型在测试集中予以验证,得出的预测准确率为98.72%,召回率为78.95%,ROC曲线下面积(AUC)为0.96。结论:随机森林模型虽然召回率有待提高,但整体准确性相当出色,能有效地避免将阳性病例误判为阴性病例,是一种可以被用来预测扁桃体术后出血率和临床医疗决策的有用工具,为后续优化提升奠定了良好基础。
Objective Hemorrhage after tonsil surgery in children is a serious and potentially life-threatening complication.The purpose of this study was to establish a risk warning model for hemorrhage after tonsil surgery in children through a national multi-center retrospective study,providing a basis for hierarchical management after tonsil surgery in children.Methods Stratified sampling was performed on 8854 children who underwent tonsillectomy under general anesthesia from 15 research centers in different provinces from January 15,2022 to May 15,2023.The sample size of this study was 2724 cases,including 1096 males and 1628 females.Children were divided into bleeding and non-bleeding groups according to whether or not they had bleeding after surgery.The random forest algorithm was used to build a risk warning model.By continuously exploring the optimized model,the accuracy of predicting the postoperative bleeding rate of tonsils in children was improved,and the prediction effectiveness of the model was verified by ten-fold cross-validation.Results Among 2724 children,117 had postoperative bleeding after tonsillectomy,with a bleeding rate of 4.30%.The model constructed by the random forest algorithm for the training set was verified in the test set,and the obtained prediction accuracy was 98.72%,the recall rate was 78.95%,and the area under the ROC curve AUC was 0.96.Conclusion Although the recall rate of the random forest model needs to be improved,the overall accuracy is quite excellent.It can effectively avoid misjudging positive cases as negative cases.It is a useful tool that can be used to predict the postoperative bleeding rate of tonsils and clinical medical decision-making,laying a good foundation for subsequent optimization and improvement.
作者
徐宏鸣
仇书要
王金霞
韩富根
夏忠芳
倪丽艳
马静
陈春光
高兴强
张军梅
刘海霞
刘海兵
姚红兵
庄强尔
宋伟
赵斯君
张明君
刘大波
李晓艳
XU Hongming;QIU Shuyao;WANG Jinxia;HAN Fugen;XIA Zhongfang;NI Liyan;MA Jing;CHEN Chunguang;GAO Xingqiang;ZHANG Junmei;LIU Haixia;LIU Haibing;YAO Hongbing;ZHUANG Qiang'er;SONG Wei;ZHAO Sijun;ZHANG Mingjun;LIU Dabo;LI Xiaoyan(Department of Otorhinolaryngology Head and Neck Surgery,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200062,China;Department of Pediatric Otorhinolaryngology,Shenzhen Hospital,Southern Medical University;Clinical Research Unit,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University;Department of Otorhinolaryngology Head and Neck Surgery,the Affiliated Children's Hospital of Zhengzhou University/Henan Children's Hospital/Zhengzhou Children's Hospital;Department of Otolaryngology,Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital),Tongji Medical College,Huazhong University of Science&Technology;Department of Otolaryngology Head and Neck Surgery,the Second Affiliated Hospital of Wenzhou Medical University;Department of Otorhinolaryngology Head and Neck Surgery,Kunming Children's Hospital;Department of Otorhinolaryngology Head and Neck Surgery,Anyang Maternal and Child Health Hospital;Department of Otorhinolaryngology Head and Neck Surgery,Xiamen Children's Hospital;Department of Otorhinolaryngology Head and Neck Surgery,Tianjin Children's Hospital;Department of Otorhinolaryngology,Shanxi Children's Hospital Shanxi Maternal and Child Health Hospital;Department of Otorhinolaryngology Head and Neck Surgery,Sichuan Provincial Maternity and Child Health Care Hospital;Department of Otorhinolaryngology Head and Neck Surgery,Children's Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Structural Birth Defect and Reconstruction;Department of Otorhinolaryngology Head and Neck Surgery,Affiliated Children's Hospital of Jiangnan University;Department of Otorhinolaryngology Head and Neck Surgery,Dalian Women and Children's Medical Group;Department of Otorhinolaryngology Head and Neck Surgery,Hunan Children's Hospital)
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2024年第10期883-890,共8页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
关键词
儿童
扁桃体切除术
术后出血
多中心
随机森林
预测
children
tonsillectomy
postoperative bleeding
multi center
random forest
forecast
