Screening for pediatric abusive head trauma: Are three variables enough?

Creator(s)

Kent P. Hymel
Wouter Karst
Mark Marinello
Bruce E. Herman
Terra N. Frazier, Children's Mercy HospitalFollow
Christopher L. Carroll
Veronica Armijo-Garcia
Matthew Musick
Kerri Weeks
Suzanne B. Haney
Afshin Pashai
Ming Wang
Pediatric Brain Injury Research Network (PediBIRN) Investigators

Document Type

Article

Publication Date

3-2022

Identifier

DOI: 10.1016/j.chiabu.2022.105518

Abstract

BACKGROUND: The PediBIRN 4-variable clinical decision rule (CDR) detects abusive head trauma (AHT) with 96% sensitivity in pediatric intensive care (PICU) settings. Preliminary analysis of its performance in Pediatric Emergency Department settings found that elimination of its fourth predictor variable enhanced screening accuracy.

OBJECTIVE: To compare the AHT screening performances of the "PediBIRN-4" CDR vs. the simplified 3-variable CDR in PICU settings.

PARTICIPANTS AND SETTINGS: 973 acutely head-injured children2021.

METHODS: Retrospective, secondary analysis of the combined, prospective PediBIRN data sets. AHT definitional criteria and physicians' diagnoses were applied iteratively to sort patients into abusive vs. other head trauma cohorts. Outcome measures of CDR performance included sensitivity, specificity, predictive values, likelihood ratios, ROC AUC, and the correlation between each CDR's patient-specific estimates of AHT probability and the overall positive yield of patients' completed abuse evaluations.

RESULTS: Applied accurately and consistently, both CDR's would have performed with sensitivity ≥93% and negative predictive value ≥91%. Eliminating the PediBIRN-4's fourth predictor variable resulted in significantly higher specificity (↑'d ≥19%), positive predictive value (↑'d ≥8%), and ROC AUC (↑'d ≥5%), but a 3% reduction in sensitivity. Both CDRs provided patient-specific estimates of abuse probability very strongly correlated with the positive yield of patients' completed abuse evaluations (Pearson's r = 0.95 and 0.91, p = .13).

CONCLUSION: The PediBIRN 3-variable CDR performed with greater AHT screening accuracy than the 4-variable CDR. Both are good predictors of the results of patients' subsequent completed abuse evaluations.

Journal Title

Child abuse & neglect

Volume

125

First Page

105518

Last Page

105518

Keywords

Abusive head trauma; Child abuse; Clinical decision rule; Clinical prediction rule; Screening test

Recommended Citation

Hymel KP, Karst W, Marinello M, et al. Screening for pediatric abusive head trauma: Are three variables enough?. Child Abuse Negl. 2022;125:105518. doi:10.1016/j.chiabu.2022.105518