1. A previously derived clinical prediction tool for cases of head trauma in children under 3 years of age was found to have a sensitivity of 72.3%, specificity of 85.7%, positive predictive value (PPV) or 71.2%, and negative predictive value (NPV) of 86.3%.
Study Rundown: Abusive trauma is often considered as a potential source of head injury in the pediatric population. However, there are few tools to assist clinicians in determining the likelihood of abusive head trauma. This study sought to validate a clinical prediction tool created to differentiate abusive from non-abusive head trauma.
The tool used 6 features (head or neck bruising, seizures, apnea, rib fracture, long-bone fracture, and retinal hemorrhage) in children under 3 years of age to predict the likelihood of abusive head trauma. When applied to a data set of known child abuse cases, having 3 or more of the above features was predictive of abusive head trauma.
The generalizability of this tool is limited by the study’s inclusion of patients from only 2 centers in Europe, both of which were used in the original creation of the tool. In addition, some of the cases used for validation were missing data regarding the 6 features above, which may affect the validity of the tool. However, given the limited exposure most clinicians have to child abuse, this tool may be valuable in helping physicians assess the likelihood of maltreatment in children suffering head trauma.
In-Depth: This study applied a previously derived tool for the prediction of abusive head trauma (PredAHT) to a novel cohort of 198 children from one center in the United Kingdom and one center in France. Some of the data was missing features required for use of the tool (head or neck bruising, seizures, apnea, rib fracture, long-bone fracture and retinal hemorrhage) and a statistical method was employed to infer the missing data. When ≥3 features were present in a child under 3 with head trauma, the probability of abusive head trauma was >81.5% (95% CI 63.3-91.8%). The sensitivity was 72.3% (95% CI 78.8%-90.7%), the positive predictive value was 71.2% (95% CI 60.4-81.7%) and the negative predictive value was 86.3% (95% CI 79.5-91.2%). The area under the receiver operating characteristic curve was 0.88 (95% CI 0.823-0.926).
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