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Pediatrics. 2016 Jul;138(1). pii: e20153756. doi: 10.1542/peds.2015-3756. Epub 2016 Jun 23.

Validation of the Pittsburgh Infant Brain Injury Score for Abusive Head Trauma.

Author information

1
Departments of Pediatrics, Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; rachel.berger@chp.edu.
2
Departments of Pediatrics.
3
Department of Pediatrics, University of Utah, Primary Children's Hospital, Salt Lake City, Utah;
4
Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois;
5
Radiology, and.
6
Neurologic Surgery of Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania;
7
Department of Medicine, Hofstra North Shore Long Island School of Medicine, Manhasset, New York; and.
8
Statistical Analysis and Measurement Consultants, Inc, Lanexa, Virginia.
9
Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;

Abstract

BACKGROUND:

Abusive head trauma is the leading cause of death from physical abuse. Misdiagnosis of abusive head trauma as well as other types of brain abnormalities in infants is common and contributes to increased morbidity and mortality. We previously derived the Pittsburgh Infant Brain Injury Score (PIBIS), a clinical prediction rule to assist physicians deciding which high-risk infants should undergo computed tomography of the head.

METHODS:

Well-appearing infants 30 to 364 days of age with temperature <38.3°C, no history of trauma, and a symptom associated with an increased risk of having a brain abnormality were eligible for enrollment in this prospective, multicenter clinical prediction rule validation. By using a predefined neuroimaging paradigm, subjects were classified as cases or controls. The sensitivity, specificity, and negative and positive predictive values of the rule for prediction of brain injury were calculated.

RESULTS:

A total of 1040 infants were enrolled: 214 cases and 826 controls. The 5-point PIBIS included abnormality on dermatologic examination (2 points), age ≥3.0 months (1 point), head circumference >85th percentile (1 point), and serum hemoglobin <11.2g/dL (1 point). At a score of 2, the sensitivity and specificity for abnormal neuroimaging was 93.3% (95% confidence interval 89.0%-96.3%) and 53% (95% confidence interval 49.3%-57.1%), respectively.

CONCLUSIONS:

Our data suggest that the PIBIS accurately identifies infants who would benefit from neuroimaging to evaluate for brain injury. An implementation analysis is needed before the PIBIS can be integrated into clinical practice.

PMID:
27338699
PMCID:
PMC4925074
DOI:
10.1542/peds.2015-3756
[Indexed for MEDLINE]
Free PMC Article

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