title: Validation of the Pittsburgh Infant Brain Injury Score for Abusive Head Trauma.
abstract: Abusive head trauma is the leading cause of death from physical abuse. Misdiagnosis of abusive head trauma as well as other types of brain abnormalities in infants is common and contributes to increased morbidity and mortality. We previously derived the Pittsburgh Infant Brain Injury Score (PIBIS), a clinical prediction rule to assist physicians deciding which high-risk infants should undergo computed tomography of the head.
  
  
  
  Well-appearing infants 30 to 364 days of age with temperature <38.3°C, no history of trauma, and a symptom associated with an increased risk of having a brain abnormality were eligible for enrollment in this prospective, multicenter clinical prediction rule validation. By using a predefined neuroimaging paradigm, subjects were classified as cases or controls. The sensitivity, specificity, and negative and positive predictive values of the rule for prediction of brain injury were calculated.
  
  
  
  A total of 1040 infants were enrolled: 214 cases and 826 controls. The 5-point PIBIS included abnormality on dermatologic examination (2 points), age ≥3.0 months (1 point), head circumference >85th percentile (1 point), and serum hemoglobin <11.2g/dL (1 point). At a score of 2, the sensitivity and specificity for abnormal neuroimaging was 93.3% (95% confidence interval 89.0%-96.3%) and 53% (95% confidence interval 49.3%-57.1%), respectively.
  
  
  
  Our data suggest that the PIBIS accurately identifies infants who would benefit from neuroimaging to evaluate for brain injury. An implementation analysis is needed before the PIBIS can be integrated into clinical practice.
authors.affiliation: Departments of Pediatrics, Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; rachel.berger@chp.edu.
authors.forename: Rachel Pardes
authors.initials: RP
authors.lastname: Berger
authors.affiliation: Departments of Pediatrics.
authors.forename: Janet
authors.initials: J
authors.lastname: Fromkin
authors.affiliation: Department of Pediatrics, University of Utah, Primary Children's Hospital, Salt Lake City, Utah;
authors.forename: Bruce
authors.initials: B
authors.lastname: Herman
authors.affiliation: Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois;
authors.forename: Mary Clyde
authors.initials: MC
authors.lastname: Pierce
authors.affiliation: Departments of Pediatrics.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Saladino
authors.affiliation: Radiology, and.
authors.forename: Lynda
authors.initials: L
authors.lastname: Flom
authors.affiliation: Neurologic Surgery of Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania;
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Tyler-Kabara
authors.affiliation: Department of Medicine, Hofstra North Shore Long Island School of Medicine, Manhasset, New York; and.
authors.forename: Tom
authors.initials: T
authors.lastname: McGinn
authors.affiliation: Statistical Analysis and Measurement Consultants, Inc, Lanexa, Virginia.
authors.forename: Rudolph
authors.initials: R
authors.lastname: Richichi
authors.affiliation: Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Kochanek
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis* / Q000209:etiology; D016022:Case-Control Studies; D002649:Child Abuse / Q000175:diagnosis*; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D008297:Male; D059906:Neuroimaging; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed