title: Validation of a clinical prediction rule for pediatric abusive head trauma.
abstract: OBJECTIVE
  To reduce missed cases of pediatric abusive head trauma (AHT), Pediatric Brain Injury Research Network investigators derived a 4-variable AHT clinical prediction rule (CPR) with sensitivity of .96. Our objective was to validate the screening performance of this AHT CPR in a new, equivalent patient population.
  
  
  METHODS
  We conducted a prospective, multicenter, observational, cross-sectional study. Applying the same inclusion criteria, definitional criteria for AHT, and methods used in the completed derivation study, Pediatric Brain Injury Research Network investigators captured complete clinical, historical, and radiologic data on 291 acutely head-injured children <3 years of age admitted to PICUs at 14 participating sites, sorted them into comparison groups of abusive and nonabusive head trauma, and measured the screening performance of the AHT CPR.
  
  
  RESULTS
  In this new patient population, the 4-variable AHT CPR demonstrated sensitivity of .96, specificity of .46, positive predictive value of .55, negative predictive value of .93, positive likelihood ratio of 1.67, and negative likelihood ratio of 0.09. Secondary analysis revealed that the AHT CPR identified 98% of study patients who were ultimately diagnosed with AHT.
  
  
  CONCLUSIONS
  Four readily available variables (acute respiratory compromise before admission; bruising of the torso, ears, or neck; bilateral or interhemispheric subdural hemorrhages or collections; and any skull fractures other than an isolated, unilateral, nondiastatic, linear, parietal fracture) identify AHT with high sensitivity in young, acutely head-injured children admitted to the PICU.
authors.affiliation: Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Departments of Pediatrics, and kphymel@gmail.com.
authors.forename: Kent P
authors.initials: KP
authors.lastname: Hymel
authors.affiliation: Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas;
authors.forename: Veronica
authors.initials: V
authors.lastname: Armijo-Garcia
authors.affiliation: Department of Emergency Medicine, Children's Hospital of Richmond at Virginia Commonwealth University Health System, Richmond, Virginia;
authors.forename: Robin
authors.initials: R
authors.lastname: Foster
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri;
authors.forename: Terra N
authors.initials: TN
authors.lastname: Frazier
authors.affiliation: Department of Pediatrics, DeVos Children's Hospital, Grand Rapids, Michigan;
authors.forename: Michael
authors.initials: M
authors.lastname: Stoiko
authors.affiliation: Department of Critical Care, Dell Children's Medical Center of Central Texas, Austin, Texas;
authors.forename: LeeAnn M
authors.initials: LM
authors.lastname: Christie
authors.affiliation: Children's Physician Services of South Texas, Driscoll Children's Hospital, Corpus Christi, Texas; Department of Pediatrics, University of Minnesota Children's Hospital, Minneapolis, Minnesota;
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Harper
authors.affiliation: Department of Pediatrics, University of Kansas School of Medicine, Wichita, Kansas;
authors.forename: Kerri
authors.initials: K
authors.lastname: Weeks
authors.affiliation: Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut;
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Carroll
authors.affiliation: Department of Pediatrics, Children's Hospital of Central California, Madera, California;
authors.forename: Phil
authors.initials: P
authors.lastname: Hyden
authors.affiliation: Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado;
authors.forename: Andrew
authors.initials: A
authors.lastname: Sirotnak
authors.affiliation: Department of Pediatrics, Children's Hospital of Omaha, Omaha, Nebraska; and.
authors.forename: Edward
authors.initials: E
authors.lastname: Truemper
authors.affiliation: Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Ornstein
authors.affiliation: Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania;
authors.forename: Ming
authors.initials: M
authors.lastname: Wang
mesh_terms: D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data*; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014481:United States
keywords: abusive head trauma; child abuse; decision rule; nonaccidental trauma; prediction rule; predictors; screening tools