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External validation of the PediBIRN clinical prediction rule for abusive head trauma

Pfeiffer, Helen, Smith, Anne, Kemp, Alison ORCID:, Cowley, Laura, Cheek, John, Dalziel, Stuart, Borland, Meredith, O'Brien, Sharon, Bonish, Megan, Neutze, Jocelyn, Oakley, Ed, Crowe, Louise, Hearps, Stephen, Lyttle, Mark, Bressan, Silvia and Babl, Franz E 2018. External validation of the PediBIRN clinical prediction rule for abusive head trauma. Pediatrics 141 (5) , e20173674. 10.1542/peds.2017-3674
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Background and Objectives: A 4-variable abusive head trauma (AHT) clinical prediction rule (CPR) for use in the Pediatric Intensive Care Unit (PICU) was derived and validated for children <3 years by the Pediatric Brain Injury Research Network (PediBIRN). We set out to externally validate PediBIRN as designed (PICU only), and using broader inclusion criteria (admitted children with head injuries (HIs)). Methods: Secondary analysis of a prospective multicenter study of pediatric HIs of patients with possible AHT at five Australian and New Zealand tertiary pediatric centers. Possible AHT was identified by clinician suspicion, epidemiology codes or a high-risk group (<3 years, admitted, abnormal neuroimaging). At one center we additionally reviewed HIs in the forensic database. We assigned cases as AHT positive, negative or indeterminate following multidisciplinary review and applied the PediBIRN CPR, blinded to outcome, to two populations; PICU admissions only and any HI admissions. CPR accuracy was calculated with 95% confidence intervals. Results: 176 cases <3 years were reviewed. 141 were admitted with abnormal neuroimaging. 28 (20%) were AHT positive; 94 (67%) AHT negative; 19 (14%) indeterminate. Excluding indeterminate cases, in the PICU (n=28) the CPR had a sensitivity of 100% (75%–100%) and specificity of 11% (0%–48%); in all admitted cases (n=141), it had a sensitivity of 96% (82%–100%) and specificity of 43% (32%–53%). Conclusion: A validation of PediBIRN on an external dataset demonstrated high sensitivity and low specificity for PICU patients. The specificity was improved but moderate in a broader group of admitted HI cases.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: American Academy of Pediatrics
ISSN: 0031-4005
Date of First Compliant Deposit: 5 March 2018
Date of Acceptance: 13 February 2018
Last Modified: 23 Oct 2022 23:33

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