Kent P Hymel1, Veronica Armijo-Garcia2, Robin Foster3, Terra N Frazier4, Michael Stoiko5, LeeAnn M Christie6, Nancy S Harper7, Kerri Weeks8, Christopher L Carroll9, Phil Hyden10, Andrew Sirotnak11, Edward Truemper12, Amy E Ornstein13, Ming Wang14. 1. Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Departments of Pediatrics, and kphymel@gmail.com. 2. Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas; 3. Department of Emergency Medicine, Children's Hospital of Richmond at Virginia Commonwealth University Health System, Richmond, Virginia; 4. Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri; 5. Department of Pediatrics, DeVos Children's Hospital, Grand Rapids, Michigan; 6. Department of Critical Care, Dell Children's Medical Center of Central Texas, Austin, Texas; 7. Children's Physician Services of South Texas, Driscoll Children's Hospital, Corpus Christi, Texas; Department of Pediatrics, University of Minnesota Children's Hospital, Minneapolis, Minnesota; 8. Department of Pediatrics, University of Kansas School of Medicine, Wichita, Kansas; 9. Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut; 10. Department of Pediatrics, Children's Hospital of Central California, Madera, California; 11. Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado; 12. Department of Pediatrics, Children's Hospital of Omaha, Omaha, Nebraska; and. 13. Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia. 14. Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania;
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 AHT with high sensitivity in young, acutely head-injured children admitted to the PICU.
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 AHT with high sensitivity in young, acutely head-injured children admitted to the PICU.
Authors: Kent P Hymel; Gloria Lee; Stephen Boos; Wouter A Karst; Andrew Sirotnak; Suzanne B Haney; Antoinette Laskey; Ming Wang Journal: J Pediatr Date: 2020-01-09 Impact factor: 4.406
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
Authors: Daniel M Lindberg; Joanne N Wood; Kristine A Campbell; Philip V Scribano; Antoinette Laskey; John M Leventhal; Mary Clyde Pierce; Desmond K Runyan Journal: Child Abuse Negl Date: 2017-02-03
Authors: Kent P Hymel; Wouter Karst; Mark Marinello; Bruce E Herman; Terra N Frazier; Christopher L Carroll; Veronica Armijo-Garcia; Matthew Musick; Kerri Weeks; Suzanne B Haney; Afshin Pashai; Ming Wang Journal: Child Abuse Negl Date: 2022-01-22
Authors: Devon M Kratchman; Porcia Vaughn; Ligia Batista Silverman; Kristine A Campbell; Daniel M Lindberg; James D Anderst; Angela N Bachim; Rachel P Berger; Kent P Hymel; Megan Letson; John D Melville; Joanne N Wood Journal: Child Abuse Negl Date: 2022-06-27
Authors: Kent P Hymel; Amanda K Fingarson; Mary Clyde Pierce; Kim Kaczor; Kathi L Makoroff; Ming Wang Journal: Pediatr Emerg Care Date: 2022-03-02 Impact factor: 1.602
Authors: Kent P Hymel; Antoinette L Laskey; Kathryn R Crowell; Ming Wang; Veronica Armijo-Garcia; Terra N Frazier; Kelly S Tieves; Robin Foster; Kerri Weeks Journal: J Pediatr Date: 2018-03-29 Impact factor: 4.406
Authors: Kent P Hymel; Veronica Armijo-Garcia; Matthew Musick; Mark Marinello; Bruce E Herman; Kerri Weeks; Suzanne B Haney; Terra N Frazier; Christopher L Carroll; Natalie N Kissoon; Reena Isaac; Robin Foster; Kristine A Campbell; Kelly S Tieves; Nina Livingston; Ashley Bucher; Maria C Woosley; Dorinda Escamilla-Padilla; Nancy Jaimon; Lucinda Kustka; Ming Wang; Vernon M Chinchilli; Mark S Dias; Jennie Noll Journal: J Pediatr Date: 2021-03-31 Impact factor: 6.314