Clinical prediction rules for abusive head trauma: a systematic review

Pfeiffer, Helena; Crowe, Louise; Kemp, Alison; Cowley, Laura; Smith, Andrew; Babl, Franz E

doi:10.1136/archdischild-2017-313748

Cited by 27 publications

(18 citation statements)

References 28 publications

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“…This is also in keeping with Hettler and Greenes’ finding that no history of trauma had a high specificity for the detection of injuries inflicted by caregivers . In young patients with HI and unclear history of trauma, clinical prediction rules for AHT may assist clinicians in deciding which patients to evaluate for abuse …”

Section: Discussionsupporting

confidence: 75%

Paediatric intentional head injuries in the emergency department: A multicentre prospective cohort study

Babl

Pfeiffer

Dalziel

et al. 2018

Emerg Medicine Australasia

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Section: Discussionsupporting

confidence: 75%

Paediatric intentional head injuries in the emergency department: A multicentre prospective cohort study

Babl

Pfeiffer

Dalziel

et al. 2018

Emerg Medicine Australasia

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“…1). From this set of results, 93 full-text articles were reviewed for inclusion, of which 19 new articles (representing 18 studies) were included [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. In addition, the 13 studies evaluated in the Bailhache et al review [43][44][45][46][47][48][49][50][51][52][53][54][55] were included in this review update, for a total of 32 articles (31 studies).…”

Section: Resultsmentioning

confidence: 99%

“…Pfeiffer et al [41] evaluated the Pediatric Brain Injury Research Network clinical prediction rule. This clinical prediction rule evaluated the likelihood of abusive head trauma in acutely head-injured children under 3 years of age admitted to the post-intensive care unit.…”

Section: Clinical Predication Rules and Predictive Symptomsmentioning

confidence: 99%

Identifying children exposed to maltreatment: a systematic review update

et al. 2020

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Background: Child maltreatment affects a significant number of children globally. Strategies have been developed to identify children suspected of having been exposed to maltreatment with the aim of reducing further maltreatment and impairment. This systematic review evaluates the accuracy of strategies for identifying children exposed to maltreatment. Methods: We conducted a systematic search of seven databases: Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane Libraries, Sociological Abstracts and the Education Resources Information Center. We included studies published from 1961 to July 2, 2019 estimating the accuracy of instruments for identifying potential maltreatment of children, including neglect, physical abuse, emotional abuse, and sexual abuse. We extracted data about accuracy and narratively synthesised the evidence. For five studies-where the population and setting matched known prevalence estimates in an emergency department setting-we calculated false positives and negatives. We assessed risk of bias using QUADAS-2. Results: We included 32 articles (representing 31 studies) that evaluated various identification strategies, including three screening tools (SPUTOVAMO checklist, Escape instrument, and a 6-item screening questionnaire for child sex trafficking). No studies evaluated the effects of identification strategies on important outcomes for children. All studies were rated as having serious risk of bias (often because of verification bias). The findings suggest that use of the SPUTOVAMO and Escape screening tools at the population level (per 100,000) would result in hundreds of children being missed and thousands of children being over identified. Conclusions: There is low to very low certainty evidence that the use of screening tools may result in high numbers of children being falsely suspected or missed. These harms may outweigh the potential benefits of using such tools in practice (PROSPERO 2016:CRD42016039659).

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“…ED‐based reports have mainly focused on demographics rather than clinical presentation . CDRs have been developed to determine children at increased risk of AHT; while Berger validated an ED based prediction rule, it did not provide a comparison between AHT and non‐AHT cases in terms of presentation …”

Section: Discussionmentioning

confidence: 99%

Paediatric abusive head trauma in the emergency department: A multicentre prospective cohort study

Babl

Pfeiffer

Kelly

et al. 2019

J Paediatrics Child Health

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Aim: Abusive head trauma (AHT) is associated with high morbidity and mortality. We aimed to describe characteristics of cases where clinicians suspected AHT and confirmed AHT cases and describe how they differed. Methods: This was a planned secondary analysis of a prospective multicentre cohort study of head injured children aged <18 years across five centres in Australia and New Zealand. We identified cases of suspected AHT when emergency department clinicians raised suspicion on a clinical report form or based on research assistant-assigned epidemiology codes. Cases were categorised as AHT positive, negative and indeterminate after multidisciplinary review. Suspected and confirmed AHT and non-AHT cases were compared using odds ratios with 95% confidence intervals. Results: AHT was suspected in 70 of 13 371 (0.5%) head-injured children. Of these, 23 (32.9%) were categorised AHT positive, 18 (25.7%) AHT indeterminate and 29 (27.1%) AHT negative. Median age was 0.8 years in suspected, 1.4 years in confirmed AHT and 4.1 years in non-AHT cases. Odds ratios (95% confidence interval) for presenting features and outcomes in confirmed AHT versus non-AHT were: loss of consciousness 2.8 (1.2-6.9), scalp haematoma 3.9 (1.7-9.0), seizures 12.0 (4.0-35.5), Glasgow coma scale ≤12 30.3 (11.8-78.0), abnormal neuroimaging 38.3 (16.8-87.5), intensive care admission 53.4 (21.6-132.5) and mortality 105.5 (22.2-500.4). Conclusions: Emergency department presentations of children with suspected and confirmed AHT had higher rates of loss of consciousness, scalp haematomas, seizures and low Glasgow coma scale. These cases were at increased risk of abnormal computed tomography scans, need for intensive care and death.

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Clinical prediction rules for abusive head trauma: a systematic review

Cited by 27 publications

References 28 publications

Paediatric intentional head injuries in the emergency department: A multicentre prospective cohort study

Paediatric intentional head injuries in the emergency department: A multicentre prospective cohort study

Identifying children exposed to maltreatment: a systematic review update

Paediatric abusive head trauma in the emergency department: A multicentre prospective cohort study

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