Journal of Mazandaran University of Medical Sciences
مجله دانشگاه علوم پزشکی مازندران
J Mazandaran Univ Med Sci
Medical Sciences
http://jmums.mazums.ac.ir
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2022
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شناسایی بهترین مدل پارامتریک تحلیل بقا برای تعیین عوامل موثر بر طول مدت بستری بیماران سوختگی استان مازندران طی سال های 1398-1392
Identifying the Best Parametric Model of Survival Analysis to Determine the Factors Affecting the Length of Hospital Stay in Burn Patients in Mazandaran Province, 2013-2019
آمار زیستی
Biostatistics
پژوهشي-کامل
Research(Original)
<span style="font-size:12pt"><span style="line-height:85%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman","serif""><span lang="FA" style="line-height:85%"><span style="font-family:"B Koodak""><span style="color:black"><span style="letter-spacing:-.1pt">سابقه</span></span></span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Koodak""><span style="color:black"><span style="letter-spacing:-.1pt"> و هدف:</span></span></span></span> <span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">شاخص طول مدت بستری</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar"">،</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar""> معیار مناسبی برای ارزیابی کیفیت مراقبت های بیمارستانی است. هدف از این مطالعه شناسایی بهترین مدل</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""></span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">های استاندارد پارامتریک تحلیل بقا برای تعیین عوامل موثر بر طول مدت بستری بیماران سوختگی می</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""></span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">باشد</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar"">.<span style="color:#0e101a"></span></span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:85%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman","serif""><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Koodak""><span style="color:black"><span style="letter-spacing:-.1pt">مواد و روش</span></span></span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""><span style="color:black"><span style="letter-spacing:-.1pt"></span></span></span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Koodak""><span style="color:black"><span style="letter-spacing:-.1pt">ها:</span></span></span></span> <span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar""><span style="letter-spacing:-.1pt">در این مطالعه مقطعی با روش سرشماری، پرونده</span></span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""><span style="letter-spacing:-.1pt"></span></span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar""><span style="letter-spacing:-.1pt">های بیمارستانی مجموع 460 بیمار سوختگی که طی سال</span></span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""><span style="letter-spacing:-.1pt"></span></span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar""><span style="letter-spacing:-.1pt">های 1392 تا 1398دربیمارستان شهید زارع ساری (تنها مرکز ارجاع بیماران سوختگی در استان مازندران) بستری بودند،</span></span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar""> مرور شد.</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar""> با استفاده از معیار ارزیابی اطلاعات آکایکه (</span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">AIC</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">)</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar"">، بهترین مدل انتخاب شد و سپس با </span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">تحلیل بقای چند متغیره بر مبنای آن مدل، عوامل موثر بر طول مدت زمان بستری شناسایی شدند. </span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar"">دادهها</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar""> با استفاده از نرم</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""></span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">افزارهای آماری </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">R ver 4.1.1</span></span><span style="line-height:85%"><span style="font-family:"B Zar""> (پکیج </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">survival</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">) و </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">SPSS</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar""> ورژن 24 در سطح معنی داری 0/05</span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">P<</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar""> پردازش شدند.</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""><span style="color:black"></span></span></span></span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:85%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman","serif""><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Koodak""><span style="color:black"><span style="letter-spacing:-.2pt">یافته</span></span></span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""><span style="color:black"><span style="letter-spacing:-.2pt"></span></span></span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Koodak""><span style="color:black"><span style="letter-spacing:-.2pt">ها:</span></span></span></span> <span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">مدل </span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">پارامتری </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">Burr</span></span><span style="line-height:85%"><span style="font-family:"B Zar""> دارای کمترین مقدار </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">AIC</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar""> (3284/92</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar"">)</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar""> و بنابراین بهترین مدل بود. متغیرهای بیماری زمینه</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""></span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">ای(دیابت)(</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar"">1/61</span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">HR=</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">، 0/68-0/28 : </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">CI</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""> 95 درصد</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">)</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar"">،</span></span> <span lang="FA" style="line-height:85%"><span style="font-family:"B Zar"">محل رخداد حادثه</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar""> (1/33</span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">HR=</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar"">، </span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">0/94-0/07 : </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">CI</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""> 95 درصد</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">)، درصد سوختگی (0/73</span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">HR=</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">، 2/53-0/28 : </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">CI</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""> 95 درصد</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">)</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar"">، </span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">و فاصله زمانی بین رخداد سوختگی تا بستری شدن (</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar"">1/69</span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">HR=</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">، 0/88-0/18 : </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">CI</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""> 95 درصد</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">)</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar"">،</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar""> به</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""></span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">طور معناداری بر طول مدت بستری تاثیرگذار بودند (0/05</span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">P<</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">).</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""></span></span></span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:85%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman","serif""><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Koodak""><span style="letter-spacing:-.2pt">استنتاج:</span></span></span> <span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">مدل</span></span><i><span dir="LTR" style="font-size:10.0pt"><span style="line-height:85%">Burr</span></span></i><span style="line-height:85%"><span style="font-family:"B Zar""> برازش بهتری در مقایسه با سایر مدل</span></span><span lang="FA" style="line-height:85%"><span style="font-family:"B Zar""></span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar"">های پارامتریک استاندارد تحلیل بقا برای تعیین عوامل موثر بر طول مدت بستری بیماران سوختگی دارد.</span></span><span lang="AR-SA" style="line-height:85%"><span style="font-family:"B Zar""><span style="letter-spacing:-.2pt"></span></span></span></span></span></span></span></span></span></span><br>
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<span style="font-size:12pt"><span style="line-height:150%"><span style="font-family:"Times New Roman","serif""><b><span style="font-size:10.0pt"><span style="line-height:150%"><span style="font-family:"Arial","sans-serif""><span style="letter-spacing:-.2pt">Background and purpose:</span></span></span></span></b> <span style="font-size:10.0pt"><span style="line-height:150%">Hospital Length of Stay (LoS) is a good indicator of the quality of hospital care. The purpose of this study was to identify the best standard models for survival analysis to determine the factors affecting the length of hospital stay in burn patients.</span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:150%"><span style="text-autospace:none"><span style="font-family:"Times New Roman","serif""><b><span style="font-size:10.0pt"><span style="line-height:150%"><span style="font-family:"Arial","sans-serif"">Materials and methods:</span></span></span></b><b> </b><span style="font-size:10.0pt"><span style="line-height:150%">In this cross-sectional study, the hospital records of 460 burn patients hospitalized in Sari Shahid Zare Hospital, 2013-2019 were reviewed. Best model was introduced using Akaike information criterion (AIC) method. Multivariate survival analysis was done and factors affecting the LoS were determined. Statistical analyses were performed using R ver. 4.1.1 (survival package) and SPSS ver. 24.</span></span></span></span></span></span></span></span>
<pre style="text-align:justify; text-indent:1.0cm">
<span style="font-size:10pt"><span style="background:#f8f9fa"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:150%"><span style="font-family:"Courier New""><b><span style="font-family:"Arial","sans-serif"">Results:</span></b><b> </b><span style="font-family:"Times New Roman","serif"">The Burr parametric model had the lowest AIC value (3284.92) and was therefore selected as the best model. Comorbidities, including diabetes (HR= 1061, 95% CI: 0.28-0.67), location of accident (HR= 1.33, 95% CI: 0.07-0.49), burn percentage (HR=0.73, 95% CI: 0.28-2.35), and time interval between burn incidence and hospitalization (HR=1.69, 95% CI: 0.18-0.88) significantly affected the duration of hospitalization (P<0.05).</span></span></span></span></span></span></span></pre>
<pre style="text-align:justify; text-indent:1.0cm">
<span style="font-size:10pt"><span style="background:#f8f9fa"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:150%"><span style="font-family:"Courier New""><b><span style="font-family:"Arial","sans-serif"">Conclusion:</span></b> <span style="font-family:"Times New Roman","serif""><span style="letter-spacing:-.1pt">The Burr model fits better than other standard parametric models of survival analysis</span></span><span style="font-family:"Times New Roman","serif""> to determine the factors affecting the length of hospital stay in burn patients.</span><span style="font-size:21.0pt"><span style="line-height:150%"><span style="font-family:"inherit","serif""></span></span></span></span></span></span></span></span></span></pre>
<span style="font-size:12pt"><span style="line-height:135%"><span style="tab-stops:121.45pt"><span style="font-family:"Times New Roman","serif""><b><i><span style="font-size:10.0pt"><span style="line-height:135%"></span></span></i></b></span></span></span></span>
مدلهای پارامتریک تحلیل بقا, توزیع (BurrXII) Burr, معیار ارزیابی اطلاعات آکایکه, طول مدت بستری, سوختگی
Parametric models of survival analysis, Burr distribution, Akaike information criterion, length of hospital stay, burn disease
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http://jmums.mazums.ac.ir/browse.php?a_code=A-10-370-30&slc_lang=fa&sid=1
Fatemeh
Safari Haji Kolaei
فاطمه
صفری حاجیکلایی
fs3530174@gmail.com