title: Potential Impact of a Validated Screening Tool for Pediatric Abusive Head Trauma.
abstract: OBJECTIVE
  To conduct a retrospective, theoretical comparison of actual pediatric intensive care unit (PICU) screening for abusive head trauma (AHT) vs AHT screening guided by a previously validated 4-variable clinical prediction rule (CPR) in datasets used by the Pediatric Brain Injury Research Network to derive and validate the CPR.
  
  
  METHODS
  We calculated CPR-based estimates of abuse probability for all 500 patients in the datasets. Next, we demonstrated a positive and very strong correlation between these estimates of abuse probability and the overall diagnostic yields of our patients' completed skeletal surveys and retinal examinations. Having demonstrated this correlation, we applied mean estimates of abuse probability to predict additional, positive abuse evaluations among patients lacking skeletal survey and/or retinal examination. Finally, we used these predictions of additional, positive abuse evaluations to extrapolate and compare AHT detection (and 2 other measures of AHT screening accuracy) in actual PICU screening for AHT vs AHT screening guided by the CPR.
  
  
  RESULTS
  Our results suggest that AHT screening guided by the CPR could theoretically increase AHT detection in PICU settings from 87%-96% (P < .001), and increase the overall diagnostic yield of completed abuse evaluations from 49%-56% (P = .058), while targeting slightly fewer, though not significantly less, children for abuse evaluation.
  
  
  CONCLUSIONS
  Applied accurately and consistently, the recently validated, 4-variable CPR could theoretically improve the accuracy of AHT screening in PICU settings.
authors.affiliation: Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Electronic address: kphymel@gmail.com.
authors.forename: Kent P
authors.initials: KP
authors.lastname: Hymel
authors.affiliation: Department of Pediatrics, University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City, UT.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Herman
authors.affiliation: Department of Pediatrics, University of Texas Health Science Center, Houston, TX.
authors.forename: Sandeep K
authors.initials: SK
authors.lastname: Narang
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.
authors.forename: Jeanine M
authors.initials: JM
authors.lastname: Graf
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.
authors.forename: Terra N
authors.initials: TN
authors.lastname: Frazier
authors.affiliation: Department of Pediatrics, DeVos Children's Hospital, Grand Rapids, MI.
authors.forename: Michael
authors.initials: M
authors.lastname: Stoiko
authors.affiliation: Department of Critical Care, Dell Children's Medical Center of Central Texas, Austin, TX.
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, TX.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Harper
authors.affiliation: Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Carroll
authors.affiliation: Department of Pediatrics, Baystate Children's Hospital, Springfield, MA.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Boos
authors.affiliation: Departments of Neurosurgery and Pediatrics, Penn State College of Medicine, Hershey, PA.
authors.forename: Mark
authors.initials: M
authors.lastname: Dias
authors.affiliation: Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Pullin
authors.affiliation: Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA.
authors.forename: Ming
authors.initials: M
authors.lastname: Wang
mesh_terms: D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000209:etiology; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015599:Trauma Severity Indices