External Validation of the PediBIRN Screening Tool for Abusive Head Trauma in Pediatric Emergency Department Settings

Kent P. Hymel*, Amanda K Fingarson, Mary Clyde Pierce, Kim Kaczor, Kathi L. Makoroff, Ming Wang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective The screening performance of the PediBIRN (Pediatric Brain Injury Research Network) abusive head trauma (AHT) 4-variable clinical decision rule (CDR) has been validated in the pediatric intensive care unit setting and in a broader setting of all hospitalized, acutely head-injured children. To further broaden the rule's clinical applicability, we sought to validate its AHT screening performance in pediatric emergency department (ED) settings. Methods We conducted a retrospective, secondary analysis of an existing, deidentified, prospective data set captured to derive a bruising CDR. Subjects were patients under 3 years with bruising and confirmed acute head trauma. An expert medical panel had previously identified patients with AHT. Measures of the CDR's AHT screening performance (sensitivity, specificity, likelihood ratios) were calculated with 95% confidence intervals (CIs). Results Expert medical panel members had classified 78 of 117 eligible patients (67%) as AHT, 38 (33%) as non-AHT, and 1 as indeterminate. Excluding the indeterminate case, the PediBIRN-4 demonstrated a sensitivity of 0.96 (95% CI, 0.88-0.99), specificity of 0.29 (95% CI, 0.16-0.46), positive likelihood ratio of 1.35 (95% CI, 1.10-1.67), and negative likelihood ratio of 0.13 (95% CI, 0.04-0.46). Close inspection of the data revealed that 1 of the CDR's predictor variables had lowered specificity without impacting sensitivity. Eliminating this variable would have increased specificity to 0.84 (95% CI, 0.68-0.93). Conclusions The PediBIRN 4-variable CDR demonstrated AHT screening sensitivity in the pediatric ED equivalent to pediatric intensive care unit and other inpatient settings, but lower specificity. Further study of a simplified 3-variable PediBIRN AHT screening tool for the ED setting is warranted.

Original languageEnglish (US)
Pages (from-to)269-272
Number of pages4
JournalPediatric emergency care
Volume38
Issue number6
DOIs
StatePublished - Jun 1 2022

Keywords

  • abusive head trauma
  • child abuse
  • decision rule
  • nonaccidental trauma
  • screening tools

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

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