A preliminary nomogram constructed for early diagnosis of bronchitis obliterans in children with severe pneumonia

BACKGROUND: To establish and internally validate a nomogram for early diagnosis of bronchitis obliterans in children with severe pneumonia. METHODS: The diagnostic model was established using a dataset of 147 pediatric patients with severe pneumonia. The clinical characteristics of bronchitis obliterans were determined using the least absolute shrinkage and selection operator method. According to the results of the multivariate logistic regression analysis, an individual nomogram was established, the C-index, calibration plot, and decision curve analysis were used to evaluate the performance of the nomogram. RESULTS: Adenovirus infection, length of symptoms, percentage of macrophages in bronchial alveolar lavage fluid, and mucosal abnormalities were all important clinical characteristics included in the nomogram. According to internal validation, the C-index of nomogram was 0.91 (C-index, 0.878 to 0.942), suggesting that the nomogram has excellent discrimination. The nomogram showed good calibration with the Hosmer-Lemeshow test demonstrating no statistical significance. The net reclassification index was 0.2022 (95% CI, 0.008 to 0.3968; P=0.042), and the integrated discrimination improvement was 0.0975 (95% CI, 0.026 to 0.169; P=0.008). Decision curve analysis showed that the nomogram is clinically useful. CONCLUSIONS: This nomogram can help clinicians make early diagnoses of bronchitis obliterans in children for whom membranous tissue has not yet formed.