Potential impact of the validated Predicting Abusive Head Trauma (PredAHT) clinical prediction tool: A clinical vignette study

Cowley, Laura E., Farewell, Daniel M. ORCID: https://orcid.org/0000-0002-8871-1653 and Kemp, Alison M. ORCID: https://orcid.org/0000-0002-1359-7948 2018. Potential impact of the validated Predicting Abusive Head Trauma (PredAHT) clinical prediction tool: A clinical vignette study. Child Abuse and Neglect 86 , pp. 184-196. 10.1016/j.chiabu.2018.09.017

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Abstract

Background The validated Predicting Abusive Head Trauma (PredAHT) tool estimates the probability of abusive head trauma (AHT) in children <3 years old with intracranial injury. Objective To explore the impact of PredAHT on clinicians’ AHT probability estimates and child protection (CP) actions, and assess inter-rater agreement between their estimates and between their CP actions, before and after PredAHT. Participants and Setting Twenty-nine clinicians from different specialties, at teaching and community hospitals. Methods Clinicians estimated the probability of AHT and indicated their CP actions in six clinical vignettes. One vignette described a child with AHT, another described a child with non-AHT, and four represented “gray” cases, where the diagnosis was uncertain. Clinicians calculated the PredAHT score, and reported whether this altered their estimate/actions. The ‘think-aloud’ method was used to capture the reasoning behind their responses. Analysis included linear modelling, linear mixed-effects modelling, chi-square tests, Fisher’s exact tests, intraclass correlation, Gwet’s AC1 coefficient and thematic analysis. Results Overall, PredAHT significantly influenced clinicians’ probability estimates in all vignettes (p < 0.001), although the impact on individual clinicians varied. However, the influence of PredAHT on clinicians’ CP actions was limited; after using PredAHT, 9/29 clinicians changed their CP actions in only 11/174 instances. Clinicians’ AHT probability estimates and CP actions varied somewhat both before and after PredAHT. Qualitative data suggested that PredAHT may increase clinicians’ confidence in their decisions when considered alongside other associated clinical, historical and social factors. Conclusions PredAHT significantly influenced clinicians’ AHT probability estimates, but had minimal impact on their CP actions.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Elsevier
ISSN:	0145-2134
Date of First Compliant Deposit:	23 October 2018
Date of Acceptance:	20 September 2018
Last Modified:	21 Nov 2024 10:00
URI:	https://orca.cardiff.ac.uk/id/eprint/116070

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