Estimating The Probability Of Abusive Head Trauma After Abuse Evaluation.
Hymel, Kent P. Wang, Ming. Chinchilli, Vernon M. Karst, Wouter A. Willson, Douglas F. Dias, Mark S. Herman, Bruce E. Carroll, Christopher L. Haney, Suzanne B. Isaac, Reena.
Published: February 2019
Child Abuse and Neglect
Vol. 88 , p. 266-274
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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. (Author abstract)
infants; preschool children; head injuries; Shaken baby syndrome; child abuse; predictor variables; MEDICAL ASPECTS OF CHILD ABUSE; SIGNS OF MALTREATMENT