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Child Abuse Negl. 2019 Feb;88:266-274. doi: 10.1016/j.chiabu.2018.11.015. Epub 2018 Dec 11.

Estimating the probability of abusive head trauma after abuse evaluation.

Author information

1
Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, United States. Electronic address: kphymel@gmail.com.
2
Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.
3
Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, the Netherlands.
4
Department of Pediatrics, Children's Hospital of Richmond, Richmond, VA, United States.
5
Departments of Neurosurgery and Pediatrics, Penn State College of Medicine, Hershey, PA, United States.
6
Department of Pediatrics, University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City, UT, United States.
7
Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, United States.
8
Department of Pediatrics, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, United States.
9
Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States.

Abstract

BACKGROUND:

Evidence-based, patient-specific estimates of abusive head trauma probability can inform physicians' decisions to evaluate, confirm, exclude, and/or report suspected child abuse.

OBJECTIVE:

To derive a clinical prediction rule for pediatric abusive head trauma that incorporates the (positive or negative) predictive contributions of patients' completed skeletal surveys and retinal exams.

PARTICIPANTS AND SETTING:

500 acutely head-injured children under three years of age hospitalized for intensive care at one of 18 sites between 2010 and 2013.

METHODS:

Secondary analysis of an existing, cross-sectional, prospective dataset, including (1) multivariable logistic regression to impute the results of abuse evaluations never ordered or completed, (2) regularized logistic regression to derive a novel clinical prediction rule that incorporates the results of completed abuse evaluations, and (3) application of the new prediction rule to calculate patient-specific estimates of abusive head trauma probability for observed combinations of its predictor variables.

RESULTS:

Applying a mean probability threshold of >0.5 to classify patients as abused, the 7-variable clinical prediction rule derived in this study demonstrated sensitivity 0.73 (95% CI: 0.66-0.79) and specificity 0.87 (95% CI: 0.82-0.90). The area under the receiver operating characteristics curve was 0.88 (95% CI: 0.85-0.92). Patient-specific estimates of abusive head trauma probability for 72 observed combinations of its seven predictor variables ranged from 0.04 (95% CI: 0.02-0.08) to 0.98 (95% CI: 0.96-0.99).

CONCLUSIONS:

Seven variables facilitate patient-specific estimation of abusive head trauma probability after abuse evaluation in intensive care settings.

KEYWORDS:

Abusive head trauma; Child abuse; Clinical prediction rule; Non-accidental trauma; Prediction tool

PMID:
30551063
PMCID:
PMC6333504
[Available on 2020-02-01]
DOI:
10.1016/j.chiabu.2018.11.015

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