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World Journal of Emergency Medicine

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Development and validation of a nomogram for predicting prolonged ICU stays after pediatric cardiac surgery

Jungang Zheng1,2,3, Wenyuan Zhang4,5, Yuqian Guo1, Huiyi Hu1, Yue Jin1, Xiangming Fang1   

  1. 1 Department of Anesthesiology and Intensive Care, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 311100, China
    2 Department of Anesthesiology and Intensive Care, the First Affiliated Hospital of Ningbo University, Ningbo 315010, China
    3 Department of Anesthesiology, the First People's Hospital of Yuexi County, Yuexi 616650, China
    4 Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310003, China
    5 Perioperative and Systems Medicine Laboratory, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310003, China
  • Contact: Xiangming Fang, Email: xmfang@zju.edu.cn; Yue Jin, Email: yue_jin@zju.edu.cn

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Abstract:

BACKGROUND: This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit (ICU) stays.

METHODS: Pediatric patients who underwent cardiac surgery were included, with data collected from the pediatric intensive care database. The datasets were randomly divided into a training set (75%) and a testing set (25%). A nomogram model was developed to predict prolonged ICU stays in the training set and then validated in the testing set.

RESULTS: A total of 795 patients and 266 patients were assigned to the training and testing sets, respectively, with consistent variables. The nomogram developed from the training set included eight characteristics: age, systolic blood pressure, respiratory rate, bicarbonate, direct bilirubin, high-sensitivity C-reactive protein, international normalized ratio, and operation time. The area under the curve values of the nomogram in the training and testing sets were 0.812 and 0.736, respectively. The nomogram demonstrated excellent discrimination and calibration. Decision curve analysis showed that the use of the nomogram resulted in more favorable outcomes compared with the strategies of treating all or none of the patients.

CONCLUSION: This study presents a nomogram that may enable early identification of high-risk patients and facilitates tailored postoperative care and better outcomes after pediatric cardiac surgery.

Key words: Pediatric, Cardiac surgery, Prolonged ICU stays, Nomogram