Abstract:

Objective Construct and validate a risk prediction model for failure of radial artery catheterization in critically ill children. Methods A total of 405 children admitted to a Grade A tertiary specialized hospital in Guangdong Province from February 2023 to April 2024 were enrolled as the modeling cohort，and 111 children admitted from May to August 2024 were selected as the validation cohort. General data，clinical diagnosis and treatment information，laboratory test results，and catheterization records of the children were prospectively collected. Univariable analysis and logistic regression analysis were performed to construct a risk prediction model for radial artery catheterization failure in critically ill children. A nomogram was plotted and the model efficacy was evaluated. Results Among the 516 children in the group，287 cases experienced catheterization failure，with a total failure rate of 55.62%（287/516）.Logistic regression analysis identified body height（length）（OR=0.978），APACHE Ⅱ score（OR=1.095），operator’s catheterization experience（OR=0.737），sedation（OR=0.415），radial artery pulsation status（moderate pulse：OR=3.292，absent pulse：OR=7.984） and hemoglobin level（OR=0.492） as independent predictors of catheterization failure. The area under the receiver operating characteristic curve of the model in the modeling cohort and the validation cohort were 0.823 and 0.774，respectively. The Hosmer-Lemeshow test indicated good model calibration（modeling cohort：χ²=7.123，P=0.624；validation cohort：χ²=9.040，P=0.434）. The clinical decision curves demonstrated that the model had good clinical utility. Conclusion The risk prediction model established in this study exhibits good predictive performance，which facilitates early identification of children with difficult radial artery catheterization by nurses and provides a reference for formulating individualized catheterization protocols.

Key words: Critically Ill Children, Radial Artery Catheterization, Influencing Factors, Risk Prediction Model, Nursing Care