Can Prediction Tools Help Identify Abusive Head Trauma?

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Abusive head trauma (AHT), also known as shaken baby syndrome, might often be missed in a clinical setting. The use of a prediction tool may help to further reduce variability in diagnosis and predict the likelihood of AHT.

Laura E. Cowley, MSc, MBPsS, BSc, of Cardiff University in the United Kingdom, and colleagues utilized a systematic review and individual patient data analysis to create the Predicting Abusive Head Trauma (PredAHT) tool, which used multilevel logistic regression to predict the likelihood of AHT.

In order to validate the PredAHT tool, Cowley and colleagues studied data from 133 non-AHT cases and 65 AHT cases obtained from two sites. Six features -- retinal hemorrhage, rib and long-bone fractures, apnea, seizures, and head or neck bruising -- were recorded, and the likelihood of an unrecorded feature being present was estimated with multiple imputation.

Of those included in the study, 97% were <24 months old. When ≥3 features were present in a child <36 months old with intracranial injury, the estimated probability of AHT was >81.5% (95%CI, 63.3-91.8). The sensitivity of the PredAHT tool was 72.3% (95% CI, 60.4-81.7), specificity was 85.7% (95% CI, 78.8-90.7) and area under the curve was 0.88 (95% CI, 0.823-0.926).

Overall, the PredAHT tool performed well and could contribute to decision-making in suspected cases of AHT. The researchers now plan an implementation study to evaluate the tool’s performance and utility in the child protection process.

Can Prediction Tools Help Identify Abusive Head Trauma?
AHT, also known as shaken baby syndrome, might often be missed in a clinical setting.

Abusive head trauma (AHT) may be missed in the clinical setting. Clinical prediction tools are used to reduce variability in practice and inform decision-making. From a systematic review and individual patient data analysis we derived the Predicting Abusive Head Trauma (PredAHT) tool, using multilevel logistic regression to predict likelihood of AHT. This study aims to externally validate the PredAHT tool.

Data included 133 non-AHT cases and 65 AHT cases, 97% of children were <24 months old. Consistent with original predictions, when ≥3 features were present in a child <36 months old with intracranial injury, the estimated probability of AHT was >81.5% (95% CI, 63.3–91.8).

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