Helena Pfeiffer1,2, Anne Smith2,3, Alison Mary Kemp4, Laura Elizabeth Cowley4, John A Cheek1,2,5, Stuart R Dalziel6,7, Meredith L Borland8,9,10, Sharon O'Brien8, Megan Bonisch6, Jocelyn Neutze11, Ed Oakley1,2,12, Louise Crowe2, Stephen J C Hearps2, Mark D Lyttle2,13,14, Silvia Bressan2,15, Franz E Babl16,2,12. 1. Emergency Department and. 2. Emergency Research Group, Murdoch Children's Research Institute, Parkville, Australia. 3. Victorian Forensic Pediatric Medical Service, The Royal Children's Hospital, Melbourne, Australia. 4. Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom. 5. Monash Medical Centre, Melbourne, Australia. 6. Starship Children's Health, Auckland, New Zealand. 7. Liggins Institute, University of Auckland, Auckland, New Zealand. 8. Princess Margaret Hospital for Children, Perth, Australia. 9. Divisions of Paediatrics and. 10. Emergency Medicine, School of Medicine, University of Western Australia, Crawley, Australia. 11. Kidzfirst Middlemore Hospital, Auckland, New Zealand. 12. Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia. 13. Bristol Royal Hospital for Children, Bristol, United Kingdom. 14. Academic Department of Emergency Care, University of the West of England, Bristol, United Kingdom; and. 15. Department of Women's and Children's Health, University of Padova, Padova, Italy. 16. Emergency Department and franz.babl@mcri.edu.au.
Abstract
BACKGROUND AND OBJECTIVES: A 4-variable abusive head trauma (AHT) clinical prediction rule (CPR) for use in the PICU was derived and validated for children <3 years of age by the Pediatric Brain Injury Research Network (PediBIRN). We aimed to externally validate PediBIRN as designed (PICU only) as well as using broader inclusion criteria (admitted children with head injuries). METHODS: This was a secondary analysis of a prospective multicenter study of pediatric head injuries at 5 Australian and New Zealand tertiary pediatric centers. Possible AHT was identified by clinician suspicion, epidemiology codes, or a high-risk group (<3 years of age, admitted, abnormal neuroimaging results). At 1 center, we additionally reviewed head injuries in the forensic database. We designated patients as positive for AHT, negative for AHT, or having indeterminate outcome after multidisciplinary review and applied the PediBIRN CPR, blinded to outcome, to PICU admissions only, and any head injury admissions. CPR accuracy was calculated by using 95% confidence intervals. RESULTS: One hundred and forty-one patients were admitted with abnormal neuroimaging results. Twenty-eight (20%) were positive for AHT, 94 (67%) were negative for AHT, and 19 (13%) had indeterminate outcome. Excluding indeterminate cases, in the PICU (n = 28), the CPR was 100% (75%-100%) sensitive and 11% (0%-48%) specific; in all admitted patients (n = 141), sensitivity was 96% (82%-100%) and specificity of 43% (32%-53%). CONCLUSIONS: This validation revealed high sensitivity and low specificity for PICU patients. Specificity was improved but moderate in a broader group of admitted head injury patients.
BACKGROUND AND OBJECTIVES: A 4-variable abusive head trauma (AHT) clinical prediction rule (CPR) for use in the PICU was derived and validated for children <3 years of age by the Pediatric Brain Injury Research Network (PediBIRN). We aimed to externally validate PediBIRN as designed (PICU only) as well as using broader inclusion criteria (admitted children with head injuries). METHODS: This was a secondary analysis of a prospective multicenter study of pediatric head injuries at 5 Australian and New Zealand tertiary pediatric centers. Possible AHT was identified by clinician suspicion, epidemiology codes, or a high-risk group (<3 years of age, admitted, abnormal neuroimaging results). At 1 center, we additionally reviewed head injuries in the forensic database. We designated patients as positive for AHT, negative for AHT, or having indeterminate outcome after multidisciplinary review and applied the PediBIRN CPR, blinded to outcome, to PICU admissions only, and any head injury admissions. CPR accuracy was calculated by using 95% confidence intervals. RESULTS: One hundred and forty-one patients were admitted with abnormal neuroimaging results. Twenty-eight (20%) were positive for AHT, 94 (67%) were negative for AHT, and 19 (13%) had indeterminate outcome. Excluding indeterminate cases, in the PICU (n = 28), the CPR was 100% (75%-100%) sensitive and 11% (0%-48%) specific; in all admitted patients (n = 141), sensitivity was 96% (82%-100%) and specificity of 43% (32%-53%). CONCLUSIONS: This validation revealed high sensitivity and low specificity for PICU patients. Specificity was improved but moderate in a broader group of admitted head injurypatients.
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; 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; 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