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

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• 作者：Kent P. Hymel ; MD¹ ; ^&lowast ; ; ^{kphymel@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Bruce E. Herman ; MD² ; Sandeep K. Narang ; MD ; JD³ ; Jeanine M. Graf ; MD⁴ ; Terra N. Frazier ; DO⁵ ; Michael Stoiko ; MD⁶ ; LeeAnn M. Christie ; MSN ; RN⁷ ; Nancy S. Harper ; MD⁸ ; ^&dagger ; ; Christopher L. Carroll ; MD ; MS⁹ ; Stephen C. Boos ; MD¹⁰ ; Mark Dias ; MD¹¹ ; Deborah A. Pullin ; BSN ; MPH¹² ; Ming Wang ; PhD¹³ ; on behalf of the Pediatric Brain Injury Research Network (PediBIRN) Investigators^&Dagger ; Douglas F. Willson ; MD ; Karen Homa ; PhD ; Douglas Lorenz ; PhD ; Reena Isaac ; MD ; Veronica Armijo-Garcia ; MD ; Robin Foster ; MD ; Kerri Weeks ; MD ; Phil Hyden ; MD ; Andrew Sirotnak ; MD ; Edward Truemper ; MD ; Amy E. Ornstein ; MDCM ; MSc
• 关键词：AHT ; Abusive head trauma ; CPR ; Clinical prediction rule ; PICU ; Pediatric intensive care unit
• 刊名：The Journal of Pediatrics
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：167
• 期：6
• 页码：1375-1381.e1
• 全文大小：403 K

文摘

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.