Construction and Validation of a Regression Model for Predicting Hemothorax in Patients with Multiple Rib Fractures

Construction and Validation of a Regression Model for Predicting Hemothorax in Patients with Multiple Rib Fractures | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Construction and Validation of a Regression Model for Predicting Hemothorax in Patients with Multiple Rib Fractures BaiLu JIANG, Yun ZHAO, HuaMing YU, DongMei MAO, GuoJiang XIONG This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8518779/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 14 You are reading this latest preprint version Abstract Objective To analyze risk factors for hemothorax in patients with multiple rib fractures and establish a nomogram prediction model. Methods A modeling cohort of 280 patients with multiple rib fractures treated at our hospital from June 2022 to June 2024 was selected. Patients were divided into a hemothorax group ( n =70) and a non-hemothorax group ( n =210). Additionally, 120 patients treated at our hospital during the same period were collected as the validation group, also divided into a hemothorax group ( n =33) and a non-hemothorax group ( n =87) based on hemothorax occurrence. General clinical data were collected. Independent risk factors were identified using a multivariate logistic regression model, and a nomogram prediction model was constructed using the “rms” package in R software. Results In the modeling cohort, patients in the hemothorax group exhibited statistically significant differences compared to the non-hemothorax group in terms of history of hypertension, number of fractures, bilateral fractures, chest injury severity score, concomitant pulmonary contusion, flail chest, white blood cell count, hemoglobin, and D-dimer ( P < 0.05). In the validation cohort, patients with multiple rib fractures and complicated hemothorax showed statistically significant differences compared to the non-complicated group in terms of history of hypertension, number of fractures, bilateral fractures, chest injury severity score, concomitant pulmonary contusion, flail chest, white blood cell count, hemoglobin, and D-dimer ( P < 0.05). Bilateral fractures, flail chest, white blood cell count, hemoglobin, and D-dimer were independent risk factors for hemothorax in patients with multiple rib fractures (P < 0.05). A nomogram prediction model was constructed based on these factors. The Hosmer-Lemeshow goodness-of-fit test revealed χ² =13.303, P =0.102 for the modeling group and χ² =8.526, P =0.384 for the validation group, indicating good consistency and model fit. The decision curve analysis revealed that the predictive model provided additional clinical net benefit when the risk threshold was set between 0.08 and 0.96 in the modeling group and between 0.08 and 0.95 in the validation group. The receiver operating characteristic curve revealed an area under the curve (AUC) of 0.854 (95% CI : 0.794–0.914) for the modeling group and 0.835 (95% CI : 0.744–0.926) for the validation group, indicating good predictive performance. Conclusion The nomogram model constructed based on bilateral fractures, flail chest, white blood cell count, hemoglobin, and D-dimer provides important strategic guidance for the predictive assessment and clinical care intervention of hemothorax in patients with multiple rib fractures. Multiple rib fractures Hemothorax Risk factors Nomogram Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 10 Mar, 2026 Reviews received at journal 27 Feb, 2026 Reviews received at journal 26 Feb, 2026 Reviewers agreed at journal 25 Feb, 2026 Reviewers agreed at journal 20 Feb, 2026 Reviewers agreed at journal 18 Feb, 2026 Reviewers agreed at journal 18 Feb, 2026 Reviews received at journal 17 Feb, 2026 Reviewers agreed at journal 17 Feb, 2026 Reviewers invited by journal 16 Feb, 2026 Editor invited by journal 09 Jan, 2026 Editor assigned by journal 08 Jan, 2026 Submission checks completed at journal 08 Jan, 2026 First submitted to journal 05 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8518779","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":593531363,"identity":"fc0a64c2-5396-4947-bf6c-9d160f592bdf","order_by":0,"name":"BaiLu JIANG","email":"","orcid":"","institution":"Jiangxi University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"BaiLu","middleName":"","lastName":"JIANG","suffix":""},{"id":593531366,"identity":"a9e639e1-9255-4b90-abf7-b9f07df1d4dd","order_by":1,"name":"Yun ZHAO","email":"","orcid":"","institution":"Affiliated Hospital of Jiangxi University of Chinese 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Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Multiple rib fractures, Hemothorax, Risk factors, Nomogram","lastPublishedDoi":"10.21203/rs.3.rs-8518779/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8518779/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective \u003c/strong\u003eTo analyze risk factors for hemothorax in patients with multiple rib fractures and establish a nomogram prediction model.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eA modeling cohort of 280 patients with multiple rib fractures treated at our hospital from June 2022 to June 2024 was selected. Patients were divided into a hemothorax group (\u003cem\u003en\u003c/em\u003e=70) and a non-hemothorax group (\u003cem\u003en\u003c/em\u003e=210). Additionally, 120 patients treated at our hospital during the same period were collected as the validation group, also divided into a hemothorax group (\u003cem\u003en\u003c/em\u003e=33) and a non-hemothorax group (\u003cem\u003en\u003c/em\u003e=87) based on hemothorax occurrence. General clinical data were collected. Independent risk factors were identified using a multivariate logistic regression model, and a nomogram prediction model was constructed using the “rms” package in R software.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e In the modeling cohort, patients in the hemothorax group exhibited statistically significant differences compared to the non-hemothorax group in terms of history of hypertension, number of fractures, bilateral fractures, chest injury severity score, concomitant pulmonary contusion, flail chest, white blood cell count, hemoglobin, and D-dimer (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). In the validation cohort, patients with multiple rib fractures and complicated hemothorax showed statistically significant differences compared to the non-complicated group in terms of history of hypertension, number of fractures, bilateral fractures, chest injury severity score, concomitant pulmonary contusion, flail chest, white blood cell count, hemoglobin, and D-dimer (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). Bilateral fractures, flail chest, white blood cell count, hemoglobin, and D-dimer were independent risk factors for hemothorax in patients with multiple rib fractures (P \u0026lt; 0.05). A nomogram prediction model was constructed based on these factors. The \u003cem\u003eHosmer-Lemeshow\u003c/em\u003egoodness-of-fit test revealed \u003cem\u003eχ²\u003c/em\u003e=13.303, \u003cem\u003eP\u003c/em\u003e=0.102 for the modeling group and \u003cem\u003eχ²\u003c/em\u003e=8.526, \u003cem\u003eP\u003c/em\u003e=0.384 for the validation group, indicating good consistency and model fit. The decision curve analysis revealed that the predictive model provided additional clinical net benefit when the risk threshold was set between 0.08 and 0.96 in the modeling group and between 0.08 and 0.95 in the validation group. The receiver operating characteristic curve revealed an area under the curve (AUC) of 0.854 (95%\u003cem\u003eCI\u003c/em\u003e: 0.794–0.914) for the modeling group and 0.835 (95% \u003cem\u003eCI\u003c/em\u003e: 0.744–0.926) for the validation group, indicating good predictive performance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e The nomogram model constructed based on bilateral fractures, flail chest, white blood cell count, hemoglobin, and D-dimer provides important strategic guidance for the predictive assessment and clinical care intervention of hemothorax in patients with multiple rib fractures.\u003c/p\u003e","manuscriptTitle":"Construction and Validation of a Regression Model for Predicting Hemothorax in Patients with Multiple Rib Fractures","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-19 19:32:08","doi":"10.21203/rs.3.rs-8518779/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-10T14:02:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-27T21:53:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-26T07:50:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"209315965353509535471236535236839960571","date":"2026-02-25T07:27:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"247982234650312477300080919322638798944","date":"2026-02-20T12:33:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"312626331615364778973882519707446332","date":"2026-02-18T20:37:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64687809368260846634575633107582528312","date":"2026-02-18T20:06:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T07:20:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31369119399298776821584298776659869112","date":"2026-02-17T05:50:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-16T14:19:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-09T13:03:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-08T11:01:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-08T10:56:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2026-01-05T08:19:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2474c6ca-4bae-4904-a92d-4714cd729da0","owner":[],"postedDate":"February 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-03-10T14:10:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-19 19:32:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8518779","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8518779","identity":"rs-8518779","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}