Kent P Hymel1, Bruce E Herman2, Sandeep K Narang3, Jeanine M Graf4, Terra N Frazier5, Michael Stoiko6, LeeAnn M Christie7, Nancy S Harper8, Christopher L Carroll9, Stephen C Boos10, Mark Dias11, Deborah A Pullin12, Ming Wang13. 1. Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: kphymel@gmail.com. 2. Department of Pediatrics, University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City, UT. 3. Department of Pediatrics, University of Texas Health Science Center, Houston, TX. 4. Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX. 5. Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO. 6. Department of Pediatrics, DeVos Children's Hospital, Grand Rapids, MI. 7. Department of Critical Care, Dell Children's Medical Center of Central Texas, Austin, TX. 8. Children's Physician Services of South Texas, Driscoll Children's Hospital, Corpus Christi, TX. 9. Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT. 10. Department of Pediatrics, Baystate Children's Hospital, Springfield, MA. 11. Departments of Neurosurgery and Pediatrics, Penn State College of Medicine, Hershey, PA. 12. Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH. 13. Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA.
Abstract
OBJECTIVE: 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.
OBJECTIVE: 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.
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: 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: 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