The devil is in the detail: A mixed-methods exploration of the utility of a clinical prediction tool to identify abusive head trauma in children less than three years of age with intracranial injury

Cowley, Laura 2018. The devil is in the detail: A mixed-methods exploration of the utility of a clinical prediction tool to identify abusive head trauma in children less than three years of age with intracranial injury. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

Abusive head trauma (AHT) is the leading cause of traumatic death in infants. The Predicting Abusive Head Trauma (PredAHT) clinical prediction rule (CPR) was developed to assist clinicians in deciding which children less than three years of age with intracranial injury require additional specialist clinical or multidisciplinary investigations for possible AHT. The impact of PredAHT has not been tested in clinical practice. However, first there is a need to understand if this is feasible, and whether PredAHT is acceptable to child protection professionals. To address this gap, a computerised version of PredAHT was developed, and a series of novel empirical studies were conducted exploring the acceptability and potential impact of PredAHT,and the feasibility of evaluating its impact in clinical practice. A literature review highlighted the many difficulties faced by clinicians in identifying AHT,suggesting that evidence-based CPRs would be of value to clinicians working in this field. A scoping review of clinical decision-making theories and the logic underpinning CPRs underscored the need for and relevance of decision support in suspected AHT cases, and informed the development of the computerised PredAHT. The computerised PredAHT provides predicted probabilities and likelihood ratios of AHT for 729 possible combinations of six clinical features (retinal haemorrhages, head/neck bruising, apnoea, seizures, rib fractures and longbone fractures), depending on whether each is present, absent, or unknown. The results show that the computerised PredAHT is acceptable to a range of child protection professionals, and has the potential to standardise the clinical investigation of AHT and provide clinicians with confidence and reassurance in their diagnostic decisions. Further feasibility and/or development work is recommended before the impact of PredAHT can be tested in a clinical trial. The studies presented in this thesis make important contributions to knowledge in the field of AHT diagnosis.

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Medicine
Subjects:	R Medicine > R Medicine (General)
Funders:	Health Care Research Wales
Date of First Compliant Deposit:	21 May 2019
Last Modified:	03 Aug 2022 01:47
URI:	https://orca.cardiff.ac.uk/id/eprint/122718

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