关键词: 多发性肋骨骨折, 血胸, 危险因素, 列线图

Abstract: Objective To analyze the risk factors for hemothorax in multiple rib fractures and construct a nomogram prediction model.Methods From June 2022 to June 2024, 400 patients with multiple rib fractures in our hospital were randomly divided into the modeling group (280 cases) and the validation group (120 cases) at a ratio of 7∶3.Based on the presence or absence of concurrent hemothorax, patients with concurrent hemothorax in the modeling group were included in the concurrent hemothorax group (70 cases), and patients without concurrent hemothorax were included in the non-concurrent hemothorax group (210 cases).Patients with hemothorax in the validation group were included in the hemothorax group (33 cases), and those without hemothorax were included in the non-hemothorax group (87 cases).Clinical data were collected, and independent risk factors were screened through a multivariate logistic regression model.The nomogram prediction model was constructed using the rms package in R software.Results In both the modeling group and the validation group, there were statistically significant differences between the group with concurrent hemothorax and the group without concurrent hemothorax in terms of history of hypertension, number of fractures, bilateral fractures, severity score of chest trauma, chest tube placement, coexisting pulmonary contusion, flail chest, white blood cells, hemoglobin, and D-dimer (P<0.05).Thoracic catheterization, flail chest, leukocyte>8.04×109/L, hemoglobin>138.13 g/L, D-dimer>1.32 mg/L were independent risk factors of multiple rib fractures complicated with hemothorax (P<0.05), and the constructed logistic regression prediction model was validated accordingly.The Hosmer-Lemeshow goodness-of-fit test results indicate that the modeling group has a χ2=6.855 (P=0.552) and the validation group has a χ2=6.147 (P=0.631), demonstrating good consistency and fit of the model.Decision curve analysis shows that when the risk threshold in the modeling group ranges between 0.08-0.98 and in the validation group exceeds 0.08, the predictive model provides additional clinical net benefits.In the receiver operating characteristic curve, the area under the curve (AUC) of the modeling group was 0.861, with a 95%CI of 0.807-0.915, and the AUC of the validation group was 0.842, with a 95%CI of 0.757-0.926.This indicates that the predictive efficacy of the model is good.Conclusion The nomogram constructed using thoracic tube placement, flail chest, white blood cell count, hemoglobin level, and D-dimer provides crucial strategic guidance for predicting and evaluating complications such as hemothorax in patients with multiple rib fractures, as well as for clinical nursing interventions.

Key words: multiple rib fractures, hemothorax, risk factors, nomogram