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Journal Article

Citation

Hymel KP, Wang M, Chinchilli VM, Karst WA, Willson DF, Dias MS, Herman BE, Carroll CL, Haney SB, Isaac R. Child Abuse Negl. 2018; 88: 266-274.

Affiliation

Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.chiabu.2018.11.015

PMID

30551063

Abstract

BACKGROUND: Evidence-based, patient-specific estimates of abusive head trauma probability can inform physicians' decisions to evaluate, confirm, exclude, and/or report suspected child abuse.

OBJECTIVE: To derive a clinical prediction rule for pediatric abusive head trauma that incorporates the (positive or negative) predictive contributions of patients' completed skeletal surveys and retinal exams. PARTICIPANTS AND SETTING: 500 acutely head-injured children under three years of age hospitalized for intensive care at one of 18 sites between 2010 and 2013.

METHODS: Secondary analysis of an existing, cross-sectional, prospective dataset, including (1) multivariable logistic regression to impute the results of abuse evaluations never ordered or completed, (2) regularized logistic regression to derive a novel clinical prediction rule that incorporates the results of completed abuse evaluations, and (3) application of the new prediction rule to calculate patient-specific estimates of abusive head trauma probability for observed combinations of its predictor variables.

RESULTS: Applying a mean probability threshold of >0.5 to classify patients as abused, the 7-variable clinical prediction rule derived in this study demonstrated sensitivity 0.73 (95% CI: 0.66-0.79) and specificity 0.87 (95% CI: 0.82-0.90). The area under the receiver operating characteristics curve was 0.88 (95% CI: 0.85-0.92). Patient-specific estimates of abusive head trauma probability for 72 observed combinations of its seven predictor variables ranged from 0.04 (95% CI: 0.02-0.08) to 0.98 (95% CI: 0.96-0.99).

CONCLUSIONS: Seven variables facilitate patient-specific estimation of abusive head trauma probability after abuse evaluation in intensive care settings.

Copyright © 2018 Elsevier Ltd. All rights reserved.


Language: en

Keywords

Abusive head trauma; Child abuse; Clinical prediction rule; Non-accidental trauma; Prediction tool

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