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Potential Impact of a Validated Screening Tool for Pediatric Abusive Head Trauma

Hymel, Kent P., MD ; Herman, Bruce E., MD ; Narang, Sandeep K., MD, JD ; Graf, Jeanine M., MD ; Frazier, Terra N., DO ; Stoiko, Michael, MD ; Christie, LeeAnn M., MSN, RN ; Harper, Nancy S., MD ; Carroll, Christopher L., MD, MS ; Boos, Stephen C., MD ; Dias, Mark, MD ; Pullin, Deborah A., BSN, MPH ; Wang, Ming, PhD

The Journal of pediatrics, 2015-12, Vol.167 (6), p.1375-1381.e1 [Periódico revisado por pares]

United States: Elsevier Inc

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Título:
Potential Impact of a Validated Screening Tool for Pediatric Abusive Head Trauma
Autor: Hymel, Kent P., MD ; Herman, Bruce E., MD ; Narang, Sandeep K., MD, JD ; Graf, Jeanine M., MD ; Frazier, Terra N., DO ; Stoiko, Michael, MD ; Christie, LeeAnn M., MSN, RN ; Harper, Nancy S., MD ; Carroll, Christopher L., MD, MS ; Boos, Stephen C., MD ; Dias, Mark, MD ; Pullin, Deborah A., BSN, MPH ; Wang, Ming, PhD
Assuntos: Child ; Child Abuse - diagnosis ; Craniocerebral Trauma - diagnosis ; Craniocerebral Trauma - etiology ; Decision Support Techniques ; Female ; Humans ; Infant ; Intensive Care Units, Pediatric ; Male ; Pediatrics ; Reproducibility of Results ; Retrospective Studies ; Trauma Severity Indices
É parte de: The Journal of pediatrics, 2015-12, Vol.167 (6), p.1375-1381.e1
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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Descrição: Objective To conduct a retrospective, theoretical comparison of actual pediatric intensive care unit (PICU) screening for abusive head trauma (AHT) vs AHT screening guided by a previously validated 4-variable clinical prediction rule (CPR) in datasets used by the Pediatric Brain Injury Research Network to derive and validate the CPR. Study design We calculated CPR-based estimates of abuse probability for all 500 patients in the datasets. Next, we demonstrated a positive and very strong correlation between these estimates of abuse probability and the overall diagnostic yields of our patients' completed skeletal surveys and retinal examinations. Having demonstrated this correlation, we applied mean estimates of abuse probability to predict additional, positive abuse evaluations among patients lacking skeletal survey and/or retinal examination. Finally, we used these predictions of additional, positive abuse evaluations to extrapolate and compare AHT detection (and 2 other measures of AHT screening accuracy) in actual PICU screening for AHT vs AHT screening guided by the CPR. Results Our results suggest that AHT screening guided by the CPR could theoretically increase AHT detection in PICU settings from 87%-96% ( P < .001), and increase the overall diagnostic yield of completed abuse evaluations from 49%-56% ( P = .058), while targeting slightly fewer, though not significantly less, children for abuse evaluation. Conclusions Applied accurately and consistently, the recently validated, 4-variable CPR could theoretically improve the accuracy of AHT screening in PICU settings.
Editor: United States: Elsevier Inc
Idioma: Inglês

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Potential Impact of a Validated Screening Tool for Pediatric Abusive Head Trauma

United States: Elsevier Inc

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