中国卒中杂志2025，Vol.20Issue(4)：428-434,7.DOI:10.3969/j.issn.1673-5765.2025.04.006
急性缺血性卒中院前延迟风险预测模型的构建及评价
Construction and Evaluation of Pre-Hospital Delay Risk Prediction Model for Acute Ischemic Stroke
摘要
Abstract
Objective To analyze the influencing factors of pre-hospital delay in acute ischemic stroke(AIS)and construct a risk prediction model.Methods AIS patients admitted to The First People's Hospital of Lianyungang from March 2021 to January 2024 were selected as research subjects.They were divided into the model group and the internal validation group.Based on pre-hospital delay conditions,the model group was further divided into the non-delayed(<3.5 h)group and the delayed(≥3.5 h)group.The data from the model group was used to establish a nomogram model,and the data from the internal validation group was used to assess the model's generalization performance.Multivariate logistic regression was used to analyze the influencing factors of pre-hospital delay in AIS patients.The rms package in R software was used to construct a nomogram prediction model for the pre-hospital delay of AIS patients.The ROC curve,calibration curve,and Hosmer-Lemeshow test were used to evaluate the predictive efficacy of the model,and the clinical decision curve was used to evaluate its clinical application value.Results A total of 268 patients with AIS were enrolled,among whom 141(52.61%)had pre-hospital delay.In patients of the model group,the delayed group was older on average(P<0.001)and had significantly higher proportions of the following characteristics:living in rural areas(P=0.004),nocturnal onset(P=0.018),without disturbance of consciousness(P=0.004),and not receiving disease knowledge education(P=0.001)compared with the non-delayed group.Multivariate logistic regression analysis showed that advanced age(OR1.082,95%CI1.038-1.128,P<0.001),living in rural areas(OR3.201,95%CI1.402-7.307,P=0.006),nocturnal onset(OR6.873,95%CI2.809-16.815,P<0.001),without disturbance of consciousness(OR4.599,95%CI1.934-10.940,P=0.001),and not receiving disease knowledge education(OR4.134,95%CI1.927-8.866,P<0.001)were independent risk factors for pre-hospital delay in AIS patients.Based on these factors,a nomogram model was developed,with higher total scores indicating an increased risk of pre-hospital delay.The ROC curve showed that the AUC of the model's prediction of pre-hospital delay was 0.822(95%CI0.763-0.880)in the model group and 0.844(95%CI0.755-0.932)in the internal validation group.In addition,both groups of data passed the Hosmer-Lemeshow test.The calibration curve showed that the predicted value of the model was relatively consistent with the true value.The clinical decision curve showed that the clinical application value of the model was reasonable.Conclusions The risk of pre-hospital delay of AIS patients is influenced by age,residence,time of onset,presence or absence of disturbance of consciousness,and whether they received disease knowledge education.The model constructed on this basis has good predictive efficacy.关键词
急性缺血性卒中/院前延迟/影响因素/预测模型Key words
Acute ischemic stroke/Pre-hospital delay/Influencing factor/Prediction model分类
医药卫生引用本文复制引用
倪佃丽,陈晓兵,张广慧,彭庆荣..急性缺血性卒中院前延迟风险预测模型的构建及评价[J].中国卒中杂志,2025,20(4):428-434,7.基金项目
江苏省"333工程"科研项目(BRA2020265) （BRA2020265）
