Validation of a clinical prediction rule for pediatric abusive head trauma

Pediatric Brain Injury Research Network (PediBIRN) Investigators

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVE: To reduce missed cases of pediatric abusive head trauma (AHT), Pediatric Brain Injury Research Network investigators derived a 4-variable AHT clinical prediction rule (CPR) with sensitivity of .96. Our objective was to validate the screening performance of this AHT CPR in a new, equivalent patient population. METHODS: We conducted a prospective, multicenter, observational, cross-sectional study. Applying the same inclusion criteria, definitional criteria for AHT, and methods used in the completed derivation study, Pediatric Brain Injury Research Network investigators captured complete clinical, historical, and radiologic data on 291 acutely head-injured children <3 years of age admitted to PICUs at 14 participating sites, sorted them into comparison groups of abusive and nonabusive head trauma, and measured the screening performance of the AHT CPR. RESULTS: In this new patient population, the 4-variable AHT CPR demonstrated sensitivity of .96, specificity of .46, positive predictive value of .55, negative predictive value of .93, positive likelihood ratio of 1.67, and negative likelihood ratio of 0.09. Secondary analysis revealed that the AHT CPR identified 98% of study patients who were ultimately diagnosed with AHT. CONCLUSIONS: Four readily available variables (acute respiratory compromise before admission; bruising of the torso, ears, or neck; bilateral or interhemispheric subdural hemorrhages or collections; and any skull fractures other than an isolated, unilateral, nondiastatic, linear, parietal fracture) identify AHTwith high sensitivity in young, acutely head-injured children admitted to the PICU.

Original languageEnglish (US)
Pages (from-to)e1537-e1544
JournalPediatrics
Volume134
Issue number6
DOIs
StatePublished - Dec 1 2014

Fingerprint

Decision Support Techniques
Craniocerebral Trauma
Pediatrics
Brain Injuries
Head
Research Personnel
Skull Fractures
Torso
Subdural Hematoma
Research
Population
Ear
Neck
Cross-Sectional Studies
Sensitivity and Specificity

Keywords

  • Abusive head trauma
  • Child abuse
  • Decision rule
  • Nonaccidental trauma
  • Prediction rule
  • Predictors
  • Screening tools

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Pediatric Brain Injury Research Network (PediBIRN) Investigators (2014). Validation of a clinical prediction rule for pediatric abusive head trauma. Pediatrics, 134(6), e1537-e1544. https://doi.org/10.1542/peds.2014-1329

Validation of a clinical prediction rule for pediatric abusive head trauma. / Pediatric Brain Injury Research Network (PediBIRN) Investigators.

In: Pediatrics, Vol. 134, No. 6, 01.12.2014, p. e1537-e1544.

Research output: Contribution to journalArticle

Pediatric Brain Injury Research Network (PediBIRN) Investigators 2014, 'Validation of a clinical prediction rule for pediatric abusive head trauma', Pediatrics, vol. 134, no. 6, pp. e1537-e1544. https://doi.org/10.1542/peds.2014-1329
Pediatric Brain Injury Research Network (PediBIRN) Investigators. Validation of a clinical prediction rule for pediatric abusive head trauma. Pediatrics. 2014 Dec 1;134(6):e1537-e1544. https://doi.org/10.1542/peds.2014-1329
Pediatric Brain Injury Research Network (PediBIRN) Investigators. / Validation of a clinical prediction rule for pediatric abusive head trauma. In: Pediatrics. 2014 ; Vol. 134, No. 6. pp. e1537-e1544.
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abstract = "BACKGROUND AND OBJECTIVE: To reduce missed cases of pediatric abusive head trauma (AHT), Pediatric Brain Injury Research Network investigators derived a 4-variable AHT clinical prediction rule (CPR) with sensitivity of .96. Our objective was to validate the screening performance of this AHT CPR in a new, equivalent patient population. METHODS: We conducted a prospective, multicenter, observational, cross-sectional study. Applying the same inclusion criteria, definitional criteria for AHT, and methods used in the completed derivation study, Pediatric Brain Injury Research Network investigators captured complete clinical, historical, and radiologic data on 291 acutely head-injured children <3 years of age admitted to PICUs at 14 participating sites, sorted them into comparison groups of abusive and nonabusive head trauma, and measured the screening performance of the AHT CPR. RESULTS: In this new patient population, the 4-variable AHT CPR demonstrated sensitivity of .96, specificity of .46, positive predictive value of .55, negative predictive value of .93, positive likelihood ratio of 1.67, and negative likelihood ratio of 0.09. Secondary analysis revealed that the AHT CPR identified 98{\%} of study patients who were ultimately diagnosed with AHT. CONCLUSIONS: Four readily available variables (acute respiratory compromise before admission; bruising of the torso, ears, or neck; bilateral or interhemispheric subdural hemorrhages or collections; and any skull fractures other than an isolated, unilateral, nondiastatic, linear, parietal fracture) identify AHTwith high sensitivity in young, acutely head-injured children admitted to the PICU.",
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author = "{Pediatric Brain Injury Research Network (PediBIRN) Investigators} and Hymel, {Kent P.} and Veronica Armijo-Garcia and Robin Foster and Frazier, {Terra N.} and Michael Stoiko and Christie, {Lee Ann M.} and Harper, {Nancy S.} and Kerri Weeks and Carroll, {Christopher L.} and Phil Hyden and Andrew Sirotnak and Edward Truemper and Ornstein, {Amy E.} and Ming Wang",
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AU - Pediatric Brain Injury Research Network (PediBIRN) Investigators

AU - Hymel, Kent P.

AU - Armijo-Garcia, Veronica

AU - Foster, Robin

AU - Frazier, Terra N.

AU - Stoiko, Michael

AU - Christie, Lee Ann M.

AU - Harper, Nancy S.

AU - Weeks, Kerri

AU - Carroll, Christopher L.

AU - Hyden, Phil

AU - Sirotnak, Andrew

AU - Truemper, Edward

AU - Ornstein, Amy E.

AU - Wang, Ming

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N2 - BACKGROUND AND OBJECTIVE: To reduce missed cases of pediatric abusive head trauma (AHT), Pediatric Brain Injury Research Network investigators derived a 4-variable AHT clinical prediction rule (CPR) with sensitivity of .96. Our objective was to validate the screening performance of this AHT CPR in a new, equivalent patient population. METHODS: We conducted a prospective, multicenter, observational, cross-sectional study. Applying the same inclusion criteria, definitional criteria for AHT, and methods used in the completed derivation study, Pediatric Brain Injury Research Network investigators captured complete clinical, historical, and radiologic data on 291 acutely head-injured children <3 years of age admitted to PICUs at 14 participating sites, sorted them into comparison groups of abusive and nonabusive head trauma, and measured the screening performance of the AHT CPR. RESULTS: In this new patient population, the 4-variable AHT CPR demonstrated sensitivity of .96, specificity of .46, positive predictive value of .55, negative predictive value of .93, positive likelihood ratio of 1.67, and negative likelihood ratio of 0.09. Secondary analysis revealed that the AHT CPR identified 98% of study patients who were ultimately diagnosed with AHT. CONCLUSIONS: Four readily available variables (acute respiratory compromise before admission; bruising of the torso, ears, or neck; bilateral or interhemispheric subdural hemorrhages or collections; and any skull fractures other than an isolated, unilateral, nondiastatic, linear, parietal fracture) identify AHTwith high sensitivity in young, acutely head-injured children admitted to the PICU.

AB - BACKGROUND AND OBJECTIVE: To reduce missed cases of pediatric abusive head trauma (AHT), Pediatric Brain Injury Research Network investigators derived a 4-variable AHT clinical prediction rule (CPR) with sensitivity of .96. Our objective was to validate the screening performance of this AHT CPR in a new, equivalent patient population. METHODS: We conducted a prospective, multicenter, observational, cross-sectional study. Applying the same inclusion criteria, definitional criteria for AHT, and methods used in the completed derivation study, Pediatric Brain Injury Research Network investigators captured complete clinical, historical, and radiologic data on 291 acutely head-injured children <3 years of age admitted to PICUs at 14 participating sites, sorted them into comparison groups of abusive and nonabusive head trauma, and measured the screening performance of the AHT CPR. RESULTS: In this new patient population, the 4-variable AHT CPR demonstrated sensitivity of .96, specificity of .46, positive predictive value of .55, negative predictive value of .93, positive likelihood ratio of 1.67, and negative likelihood ratio of 0.09. Secondary analysis revealed that the AHT CPR identified 98% of study patients who were ultimately diagnosed with AHT. CONCLUSIONS: Four readily available variables (acute respiratory compromise before admission; bruising of the torso, ears, or neck; bilateral or interhemispheric subdural hemorrhages or collections; and any skull fractures other than an isolated, unilateral, nondiastatic, linear, parietal fracture) identify AHTwith high sensitivity in young, acutely head-injured children admitted to the PICU.

KW - Abusive head trauma

KW - Child abuse

KW - Decision rule

KW - Nonaccidental trauma

KW - Prediction rule

KW - Predictors

KW - Screening tools

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