Potential Impact of a Validated Screening Tool for Pediatric Abusive Head Trauma

Pediatric Brain Injury Research Network (PediBIRN) Investigators

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective To conduct a retrospective, theoretical comparison of actual pediatric intensive care unit (PICU) screening for abusive head trauma (AHT) vs AHT screening guided by a previously validated 4-variable clinical prediction rule (CPR) in datasets used by the Pediatric Brain Injury Research Network to derive and validate the CPR. Study design We calculated CPR-based estimates of abuse probability for all 500 patients in the datasets. Next, we demonstrated a positive and very strong correlation between these estimates of abuse probability and the overall diagnostic yields of our patients’ completed skeletal surveys and retinal examinations. Having demonstrated this correlation, we applied mean estimates of abuse probability to predict additional, positive abuse evaluations among patients lacking skeletal survey and/or retinal examination. Finally, we used these predictions of additional, positive abuse evaluations to extrapolate and compare AHT detection (and 2 other measures of AHT screening accuracy) in actual PICU screening for AHT vs AHT screening guided by the CPR. Results Our results suggest that AHT screening guided by the CPR could theoretically increase AHT detection in PICU settings from 87%-96% (P <.001), and increase the overall diagnostic yield of completed abuse evaluations from 49%-56% (P =.058), while targeting slightly fewer, though not significantly less, children for abuse evaluation. Conclusions Applied accurately and consistently, the recently validated, 4-variable CPR could theoretically improve the accuracy of AHT screening in PICU settings.

Original languageEnglish (US)
Pages (from-to)1375-1381.e1
JournalJournal of Pediatrics
Volume167
Issue number6
DOIs
StatePublished - Dec 2015

Fingerprint

Craniocerebral Trauma
Decision Support Techniques
Pediatrics
Pediatric Intensive Care Units
Child Abuse
Brain Injuries
Research

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Pediatric Brain Injury Research Network (PediBIRN) Investigators (2015). Potential Impact of a Validated Screening Tool for Pediatric Abusive Head Trauma. Journal of Pediatrics, 167(6), 1375-1381.e1. https://doi.org/10.1016/j.jpeds.2015.09.018

Potential Impact of a Validated Screening Tool for Pediatric Abusive Head Trauma. / Pediatric Brain Injury Research Network (PediBIRN) Investigators.

In: Journal of Pediatrics, Vol. 167, No. 6, 12.2015, p. 1375-1381.e1.

Research output: Contribution to journalArticle

Pediatric Brain Injury Research Network (PediBIRN) Investigators 2015, 'Potential Impact of a Validated Screening Tool for Pediatric Abusive Head Trauma', Journal of Pediatrics, vol. 167, no. 6, pp. 1375-1381.e1. https://doi.org/10.1016/j.jpeds.2015.09.018
Pediatric Brain Injury Research Network (PediBIRN) Investigators. Potential Impact of a Validated Screening Tool for Pediatric Abusive Head Trauma. Journal of Pediatrics. 2015 Dec;167(6):1375-1381.e1. https://doi.org/10.1016/j.jpeds.2015.09.018
Pediatric Brain Injury Research Network (PediBIRN) Investigators. / Potential Impact of a Validated Screening Tool for Pediatric Abusive Head Trauma. In: Journal of Pediatrics. 2015 ; Vol. 167, No. 6. pp. 1375-1381.e1.
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abstract = "Objective To conduct a retrospective, theoretical comparison of actual pediatric intensive care unit (PICU) screening for abusive head trauma (AHT) vs AHT screening guided by a previously validated 4-variable clinical prediction rule (CPR) in datasets used by the Pediatric Brain Injury Research Network to derive and validate the CPR. Study design We calculated CPR-based estimates of abuse probability for all 500 patients in the datasets. Next, we demonstrated a positive and very strong correlation between these estimates of abuse probability and the overall diagnostic yields of our patients’ completed skeletal surveys and retinal examinations. Having demonstrated this correlation, we applied mean estimates of abuse probability to predict additional, positive abuse evaluations among patients lacking skeletal survey and/or retinal examination. Finally, we used these predictions of additional, positive abuse evaluations to extrapolate and compare AHT detection (and 2 other measures of AHT screening accuracy) in actual PICU screening for AHT vs AHT screening guided by the CPR. Results Our results suggest that AHT screening guided by the CPR could theoretically increase AHT detection in PICU settings from 87{\%}-96{\%} (P <.001), and increase the overall diagnostic yield of completed abuse evaluations from 49{\%}-56{\%} (P =.058), while targeting slightly fewer, though not significantly less, children for abuse evaluation. Conclusions Applied accurately and consistently, the recently validated, 4-variable CPR could theoretically improve the accuracy of AHT screening in PICU settings.",
author = "{Pediatric Brain Injury Research Network (PediBIRN) Investigators} and Hymel, {Kent P.} and Herman, {Bruce E.} and Narang, {Sandeep K.} and Graf, {Jeanine M.} and Frazier, {Terra N.} and Michael Stoiko and Christie, {Lee Ann M.} and Harper, {Nancy S.} and Carroll, {Christopher L.} and Boos, {Stephen C.} and Mark Dias and Pullin, {Deborah A.} and Ming Wang and Willson, {Douglas F.} and Karen Homa and Douglas Lorenz and Reena Isaac and Veronica Armijo-Garcia and Robin Foster and Kerri Weeks and Phil Hyden and Andrew Sirotnak and Edward Truemper and Ornstein, {Amy E.}",
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AU - Pediatric Brain Injury Research Network (PediBIRN) Investigators

AU - Hymel, Kent P.

AU - Herman, Bruce E.

AU - Narang, Sandeep K.

AU - Graf, Jeanine M.

AU - Frazier, Terra N.

AU - Stoiko, Michael

AU - Christie, Lee Ann M.

AU - Harper, Nancy S.

AU - Carroll, Christopher L.

AU - Boos, Stephen C.

AU - Dias, Mark

AU - Pullin, Deborah A.

AU - Wang, Ming

AU - Willson, Douglas F.

AU - Homa, Karen

AU - Lorenz, Douglas

AU - Isaac, Reena

AU - Armijo-Garcia, Veronica

AU - Foster, Robin

AU - Weeks, Kerri

AU - Hyden, Phil

AU - Sirotnak, Andrew

AU - Truemper, Edward

AU - Ornstein, Amy E.

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N2 - Objective To conduct a retrospective, theoretical comparison of actual pediatric intensive care unit (PICU) screening for abusive head trauma (AHT) vs AHT screening guided by a previously validated 4-variable clinical prediction rule (CPR) in datasets used by the Pediatric Brain Injury Research Network to derive and validate the CPR. Study design We calculated CPR-based estimates of abuse probability for all 500 patients in the datasets. Next, we demonstrated a positive and very strong correlation between these estimates of abuse probability and the overall diagnostic yields of our patients’ completed skeletal surveys and retinal examinations. Having demonstrated this correlation, we applied mean estimates of abuse probability to predict additional, positive abuse evaluations among patients lacking skeletal survey and/or retinal examination. Finally, we used these predictions of additional, positive abuse evaluations to extrapolate and compare AHT detection (and 2 other measures of AHT screening accuracy) in actual PICU screening for AHT vs AHT screening guided by the CPR. Results Our results suggest that AHT screening guided by the CPR could theoretically increase AHT detection in PICU settings from 87%-96% (P <.001), and increase the overall diagnostic yield of completed abuse evaluations from 49%-56% (P =.058), while targeting slightly fewer, though not significantly less, children for abuse evaluation. Conclusions Applied accurately and consistently, the recently validated, 4-variable CPR could theoretically improve the accuracy of AHT screening in PICU settings.

AB - Objective To conduct a retrospective, theoretical comparison of actual pediatric intensive care unit (PICU) screening for abusive head trauma (AHT) vs AHT screening guided by a previously validated 4-variable clinical prediction rule (CPR) in datasets used by the Pediatric Brain Injury Research Network to derive and validate the CPR. Study design We calculated CPR-based estimates of abuse probability for all 500 patients in the datasets. Next, we demonstrated a positive and very strong correlation between these estimates of abuse probability and the overall diagnostic yields of our patients’ completed skeletal surveys and retinal examinations. Having demonstrated this correlation, we applied mean estimates of abuse probability to predict additional, positive abuse evaluations among patients lacking skeletal survey and/or retinal examination. Finally, we used these predictions of additional, positive abuse evaluations to extrapolate and compare AHT detection (and 2 other measures of AHT screening accuracy) in actual PICU screening for AHT vs AHT screening guided by the CPR. Results Our results suggest that AHT screening guided by the CPR could theoretically increase AHT detection in PICU settings from 87%-96% (P <.001), and increase the overall diagnostic yield of completed abuse evaluations from 49%-56% (P =.058), while targeting slightly fewer, though not significantly less, children for abuse evaluation. Conclusions Applied accurately and consistently, the recently validated, 4-variable CPR could theoretically improve the accuracy of AHT screening in PICU settings.

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