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Evidence-based Medical Screening for Pediatric Abusive Head Trauma

 

PediBIRN investigators are pleased to introduce two simple and effective screening tools for pediatric Abusive Head Trauma (AHT). Both were designed to inform physicians' decisions to launch or forego abuse evaluations in their acutely head-injured patients under three years of age.

The "PediBIRN-4" identifies young, acutely head-injured patients hospitalized for intensive care who are at "higher risk" and recommends that they be thoroughly evaluated for abuse. Applied accurately and consistently, it "casts a wide net", categorizing ≥96% of AHT patients as higher risk.1,2 Its AHT screening sensitivity has been externally validated in multiple clinical settings.3,4 In a recent cluster randomized trial, PedBIRN-4 application reduced potential cases of missed AHT.5

The "PediBIRN-3" is a simplified AHT screening tool based solely on the PediBIRN 4’s first three predictor variables.6 Applied accurately and consistently, it "casts a smaller net more accurately", categorizing ≥93% of AHT patients as higher risk, but recommending fewer evaluations of patients with non-AHT. Preliminary evidence suggests the PediBIRN-3 is more acceptable to physicians, and is better suited for application in pediatric ED settings.3,6

Both screening tools can also be applied as "AHT probability calculators" that facilitate patient-specific estimation of abuse probability highly predictive (Pearson’s R ≥.91) of the overall positive yield of patients’ subsequent, completed, abuse evaluations. Their screening and prediction performances are based on analysis of prospective data regarding 973 acutely head-injured patients under 3 years of age hospitalized for intensive care across 18 participating sites.1,2,5

Table-1 PediBIRN Variables

Click here to compare and contrast their AHT screening performances.

Click here to compare and contrast their AHT prediction performances.

Selected References:

1 Hymel KP, Willson DF, Boos SC, et al. Derivation of a clinical prediction rule for pediatric abusive head trauma. Pediatr Crit Care Med 2013;14(2):210-220.

2 Hymel KP, Armijo-Garcia V, Foster R, et al. Validation of a clinical prediction rule for pediatric abusive head trauma. Pediatrics 2014;134(6):e1537-1544.

3 Hymel KP, Fingarson AK, Pierce MC, et al. External validation of the PediBIRN screening tool for abusive head trauma in pediatric emergency department settings. Pediatr Emerg Care in press.

4 Pfeiffer H, Smith A, Kemp AM, et al. External validation of the PediBIRN clinical prediction rule for abusive head trauma. Pediatrics 2018;141:e20173674.

5 Hymel KP, Armijo-Garcia V, Musick M, et al. A cluster randomized trial to reduce missed abusive head trauma in pediatric intensive care settings. J Pediatr 2021:236;260-268.

6 Hymel KP, Karst W, Marinello M, et al. Screening for pediatric abusive head trauma: Are three variables enough? Child Abuse Negl 2022:125;105518.
DOI: 10.1016/j.chiabu.2022.105518

 

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