CONTEXT AND OBJECTIVE: To determine which combinations of clinical features assist in distinguishing abusive head trauma (AHT) from nonabusive head trauma. METHODS: Individual patient data from 6 comparative studies of children younger than 3 years with intracranial injury were analyzed to determine the association between AHT and combinations of apnea; retinal hemorrhage; rib, skull, and long-bone fractures; seizures; and head and/or neck bruising. An aggregate analysis of data from these studies used multiple imputation of combined clinical features using a bespoke hotdeck imputation strategy, which accounted for uncertainty arising from missing information. RESULTS: Analyzing 1053 children (348 had AHT), excluding nonsignificant variables (gender, age, skull fractures), for a child with an intracranial injury and 1 or 2 of the 6 features, the positive predictive value (PPV) of AHT varies from 4% to 97% according to the different combinations. Although rarely recorded, apnea is significantly associated with AHT (odds ratio [OR]: 6.89 [confidence interval: 2.08-22.86]). When rib fracture or retinal hemorrhage was present with any 1 of the other features, the OR for AHT is >100 (PPV > 85%). Any combination of 3 or more of the 6 significant features yielded an OR of >100 (PPV for AHT > 85%). CONCLUSIONS: Probabilities of AHT can be estimated on the basis of different combinations of clinical features. The model could be further developed in a prospective large-scale study, with an expanded clinical data set, to contribute to a more refined tool to inform clinical decisions about the likelihood of AHT.
CONTEXT AND OBJECTIVE: To determine which combinations of clinical features assist in distinguishing abusive head trauma (AHT) from nonabusive head trauma. METHODS: Individual patient data from 6 comparative studies of children younger than 3 years with intracranial injury were analyzed to determine the association between AHT and combinations of apnea; retinal hemorrhage; rib, skull, and long-bone fractures; seizures; and head and/or neck bruising. An aggregate analysis of data from these studies used multiple imputation of combined clinical features using a bespoke hotdeck imputation strategy, which accounted for uncertainty arising from missing information. RESULTS: Analyzing 1053 children (348 had AHT), excluding nonsignificant variables (gender, age, skull fractures), for a child with an intracranial injury and 1 or 2 of the 6 features, the positive predictive value (PPV) of AHT varies from 4% to 97% according to the different combinations. Although rarely recorded, apnea is significantly associated with AHT (odds ratio [OR]: 6.89 [confidence interval: 2.08-22.86]). When rib fracture or retinal hemorrhage was present with any 1 of the other features, the OR for AHT is >100 (PPV > 85%). Any combination of 3 or more of the 6 significant features yielded an OR of >100 (PPV for AHT > 85%). CONCLUSIONS: Probabilities of AHT can be estimated on the basis of different combinations of clinical features. The model could be further developed in a prospective large-scale study, with an expanded clinical data set, to contribute to a more refined tool to inform clinical decisions about the likelihood of AHT.
Authors: Arabinda Kumar Choudhary; Sabah Servaes; Thomas L Slovis; Vincent J Palusci; Gary L Hedlund; Sandeep K Narang; Joëlle Anne Moreno; Mark S Dias; Cindy W Christian; Marvin D Nelson; V Michelle Silvera; Susan Palasis; Maria Raissaki; Andrea Rossi; Amaka C Offiah Journal: Pediatr Radiol Date: 2018-05-23
Authors: Mehmet Gencturk; Huseyin Gurkan Tore; David R Nascene; Lei Zhang; Yasemin Koksel; Alexander M McKinney Journal: Clin Neuroradiol Date: 2018-01-23 Impact factor: 3.649
Authors: Kent P Hymel; Ming Wang; Vernon M Chinchilli; Wouter A Karst; Douglas F Willson; Mark S Dias; Bruce E Herman; Christopher L Carroll; Suzanne B Haney; Reena Isaac Journal: Child Abuse Negl Date: 2018-12-11