Kent P Hymel1, Gloria Lee2, Stephen Boos3, Wouter A Karst4, Andrew Sirotnak5, Suzanne B Haney6, Antoinette Laskey7, Ming Wang8. 1. Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA. Electronic address: khymel@pennstatehealth.psu.edu. 2. Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA. 3. Department of Pediatrics, Baystate Medical Center, Springfield, MA. 4. Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, the Netherlands. 5. Department of Pediatrics, University of Colorado School of Medicine, Denver, CO. 6. Department of Pediatrics, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE. 7. Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT. 8. Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA.
Abstract
OBJECTIVE: To replicate the previously published finding that the absence of a history of trauma in a child with obvious traumatic head injuries demonstrates high specificity and high positive predictive value (PPV) for abusive head trauma. STUDY DESIGN: This was a secondary analysis of a deidentified, cross-sectional dataset containing prospective data on 346 young children with acute head injury hospitalized for intensive care across 18 sites between 2010 and 2013, to estimate the diagnostic relevance of a caregiver's specific denial of any trauma, changing history of accidental trauma, or history of accidental trauma inconsistent with the child's gross motor skills. Cases were categorized as definite or not definite abusive head trauma based solely on patients' clinical and radiologic findings. For each presumptive historical "red flag," we calculated sensitivity, specificity, predictive values, and likelihood ratio (LR) with 95% CI for definite abusive head trauma in all patients and also in cohorts with normal, abnormal, or persistent abnormal neurologic status. RESULTS: A caregiver's specific denial of any trauma demonstrated a specificity of 0.90 (95% CI, 0.84-0.94), PPV of 0.81 (95% CI, 0.71-0.88), and a positive LR (LR+) of 4.83 (95% CI, 3.07-7.61) for definite abusive head trauma in all patients. Specificity and LR+ were lowest-not highest-in patients with persistent neurologic abnormalities. The 2 other historical red flags showed similar trends. CONCLUSIONS: A caregiver's specific denial of any trauma, changing history of accidental trauma, or history of accidental trauma that is developmentally inconsistent are each highly specific (>0.90) but may provide weaker support than previously reported for a diagnosis of abusive head trauma in patients with persistent neurologic abnormalities.
OBJECTIVE: To replicate the previously published finding that the absence of a history of trauma in a child with obvious traumatic head injuries demonstrates high specificity and high positive predictive value (PPV) for abusive head trauma. STUDY DESIGN: This was a secondary analysis of a deidentified, cross-sectional dataset containing prospective data on 346 young children with acute head injury hospitalized for intensive care across 18 sites between 2010 and 2013, to estimate the diagnostic relevance of a caregiver's specific denial of any trauma, changing history of accidental trauma, or history of accidental trauma inconsistent with the child's gross motor skills. Cases were categorized as definite or not definite abusive head trauma based solely on patients' clinical and radiologic findings. For each presumptive historical "red flag," we calculated sensitivity, specificity, predictive values, and likelihood ratio (LR) with 95% CI for definite abusive head trauma in all patients and also in cohorts with normal, abnormal, or persistent abnormal neurologic status. RESULTS: A caregiver's specific denial of any trauma demonstrated a specificity of 0.90 (95% CI, 0.84-0.94), PPV of 0.81 (95% CI, 0.71-0.88), and a positive LR (LR+) of 4.83 (95% CI, 3.07-7.61) for definite abusive head trauma in all patients. Specificity and LR+ were lowest-not highest-in patients with persistent neurologic abnormalities. The 2 other historical red flags showed similar trends. CONCLUSIONS: A caregiver's specific denial of any trauma, changing history of accidental trauma, or history of accidental trauma that is developmentally inconsistent are each highly specific (>0.90) but may provide weaker support than previously reported for a diagnosis of abusive head trauma in patients with persistent neurologic abnormalities.
Authors: Kent P Hymel; Veronica Armijo-Garcia; Robin Foster; Terra N Frazier; Michael Stoiko; LeeAnn M Christie; Nancy S Harper; Kerri Weeks; Christopher L Carroll; Phil Hyden; Andrew Sirotnak; Edward Truemper; Amy E Ornstein; Ming Wang Journal: Pediatrics Date: 2014-11-17 Impact factor: 7.124
Authors: Kent P Hymel; Douglas F Willson; Stephen C Boos; Deborah A Pullin; Karen Homa; Douglas J Lorenz; Bruce E Herman; Jeanine M Graf; Reena Isaac; Veronica Armijo-Garcia; Sandeep K Narang Journal: Pediatr Crit Care Med Date: 2013-02 Impact factor: 3.624
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