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

Hymel, Kent P.; Herman, Bruce; Narang, Sandeep K.; Graf, Jeanine M.; Frazier, Terra N.; Stoiko, Michael; Christie, Lee Ann M.; Harper, Nancy S.; Carroll, Christopher L.; Boos, Stephen C.; Dias, Mark S.; Pullin, Deborah A.; Wang, Ming

doi:10.1016/j.jpeds.2015.09.018

Cited by 19 publications

(22 citation statements)

References 23 publications

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“…The high prevalence of occult fractures in children with AHT is in accordance with the literature [4,8,9]. Children with AHT are prone to suffer from non-accidental trauma, especially when they are young.…”

Section: Prevalence and Clinical Injuriessupporting

confidence: 87%

Prevalence and distribution of occult fractures on skeletal surveys in children with suspected non-accidental trauma imaged or reviewed in a tertiary Dutch hospital

et al. 2020

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Purpose The purpose of the study was to determine the rate of occult fractures (without clinical symptoms) per presenting clinical injury i.e., children presenting with a fracture, bruise, abusive head trauma and the types of fracture most likely to be found, in a series of infants and young children suspected of being victims of NAT. Methods Skeletal surveys done between 2008 and 2018 of children (< 5 years) were retrospectively analyzed. Both radiographs of admitted children and reassessment images from all over the country were included and reviewed by a forensic paediatric radiologist. Deceased children were excluded. Variables as gender, age, initial clinical injury and occult fractures were collected. Occult fractures on the follow-up skeletal survey were collected. Results A total of 370 skeletal surveys of 296 children were included. Median age was 22 weeks (IQR 11-48), there were 172 (58%) boys. A total of 195 occult fractures were detected in 111 (32%) children. Occult fractures were detected in 37/126 (29%) children with fracture as presenting symptom, 33/90 (37%) children with head trauma and 26/50 (52%) children with bruises. Rib (n = 56, 50%) and lower leg (n = 40, 36%) fractures were most detected. Conclusion Occult fractures were detected in 32% of the children. Occult fractures were most prevalent if the initial clinical injury suggestive for NAT to request skeletal survey was a bruise, abusive head trauma or fracture. Keywords Non accidental injury • Paediatric injury • Fractures and dislocations • x-ray • Skeletal survey Abbreviations NAT Non-accidental trauma AHT Abusive head trauma MCF Metaphyseal corner fractures CAN, Child abuse and neglect team

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Section: Prevalence and Clinical Injuriessupporting

confidence: 87%

Prevalence and distribution of occult fractures on skeletal surveys in children with suspected non-accidental trauma imaged or reviewed in a tertiary Dutch hospital

et al. 2020

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“…Hymel et al have undertaken a theoretical impact analysis of PediBIRN in the combined population of the derivation and validation study 26. Of note, because the PIBIS rule as originally derived was updated in the validation study, ideally this CPredR should be validated in another external data set before it can be applied to new patients 27…”

Section: Discussionmentioning

confidence: 99%

Clinical prediction rules for abusive head trauma: a systematic review

et al. 2018

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“…The Pediatric Brain Injury Research Network (PediBIRN) four-variable CPR is the only other CPR for paediatric AHT intended for use in an inpatient setting and was designed to assist in deciding which children with cranial or ICI admitted to the PICU should be evaluated further for abuse 26–29. In a recent external validation of PediBIRN by our group, its sensitivity was 96% and its specificity was 43% when applied to children <3 years old with ICI or cranial injury, admitted to all inpatient settings 17.…”

Section: Discussionmentioning

confidence: 99%

Validation of the PredAHT-2 prediction tool for abusive head trauma

et al. 2020

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ObjectiveThe validated Predicting Abusive Head Trauma (PredAHT) clinical prediction tool calculates the probability of abusive head trauma (AHT) in children <3 years of age who have sustained intracranial injuries (ICIs) identified on neuroimaging, based on combinations of six clinical features: head/neck bruising, seizures, apnoea, rib fracture, long bone fracture and retinal haemorrhages. PredAHT version 2 enables a probability calculation when information regarding any of the six features is absent. We aimed to externally validate PredAHT-2 in an Australian/New Zealand population.MethodsThis is a secondary analysis of a prospective multicentre study of paediatric head injuries conducted between April 2011 and November 2014. We extracted data on patients with possible AHT at five tertiary paediatric centres and included all children <3 years of age admitted to hospital who had sustained ICI identified on neuroimaging. We assigned cases as positive for AHT, negative for AHT or having indeterminate outcome following multidisciplinary review. The estimated probability of AHT for each case was calculated using PredAHT-2, blinded to outcome. Tool performance measures were calculated, with 95% CIs.ResultsOf 87 ICI cases, 27 (31%) were positive for AHT; 45 (52%) were negative for AHT and 15 (17%) had indeterminate outcome. Using a probability cut-off of 50%, excluding indeterminate cases, PredAHT-2 had a sensitivity of 74% (95% CI 54% t o89%) and a specificity of 87% (95% CI 73% to 95%) for AHT. Positive predictive value was 77% (95% CI 56% to 91%), negative predictive value was 85% (95% CI 71% to 94%) and the area under the curve was 0.80 (95% CI 0.68 to 0.92).ConclusionPredAHT-2 demonstrated reasonably high point sensitivity and specificity when externally validated in an Australian/New Zealand population. Performance was similar to that in the original validation study.Trial registration numberACTRN12614000463673.

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

Cited by 19 publications

References 23 publications

Prevalence and distribution of occult fractures on skeletal surveys in children with suspected non-accidental trauma imaged or reviewed in a tertiary Dutch hospital

Prevalence and distribution of occult fractures on skeletal surveys in children with suspected non-accidental trauma imaged or reviewed in a tertiary Dutch hospital

Clinical prediction rules for abusive head trauma: a systematic review

Validation of the PredAHT-2 prediction tool for abusive head trauma

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