Validation of the Pittsburgh Infant Brain Injury Score for Abusive Head Trauma

Abstract

BACKGROUND: Abusive head trauma is the leading cause of death from physical abuse. Misdiagnosis of abusive head trauma as well as other types of brain abnormalities in infants is common and contributes to increased morbidity and mortality. We previously derived the Pittsburgh Infant Brain Injury Score (PIBIS), a clinical prediction rule to assist physicians deciding which high-risk infants should undergo computed tomography of the head.

Clinical prediction rules for abusive head trauma: a systematic review

“…The search in PubMed and the Cochrane Database of Systematic Reviews and Cochrane Controlled Trials did not add any additional relevant studies. After removing duplicates, reviewing abstracts and excluding irrelevant articles, three recently published, externally validated CPredRs for AHT met the inclusion criteria: the Pediatric Brain Injury Research Network (PediBIRN) 4-Variable AHT CPredR,19 the Predicting Abusive Head Trauma (PredAHT) tool20 and the Pittsburgh Infant Brain Injury Score (PIBIS) for AHT21 (see figure 1 and table 1). …”

“…The PIBIS for AHT21 assists in determining which high-risk infants in the ED should undergo head CT to rule out abnormalities including AHT. It was derived based on retrospective data on 187 children (150 without brain injury and 37 with mild AHT), which were not published, and validated using logistic regression in a prospective study carried out in the USA with 1040 infants.…”

“…These prediction rules are aimed at very different populations and different time points within the clinical assessment (figure 2): PIBIS21 is targeted at a specific population of well-appearing infants in the ED who might benefit from a head CT scan. PredAHT20 applies to children <3 years of age admitted to hospital with intracranial injury, where children have been examined and may have had some ophthalmological and radiological investigations, and PediBIRN19 applies to a narrower population of <3-year-olds admitted to PICU with a cranial or intracranial injury excluding head trauma resulting from motor vehicle collisions.…”

Research priorities for a multi-center child abuse network: Lessons learned from pediatric emergency medicine networks

“…Specific predictive tools must be developed to differentiate these distinct injuries. The Pittsburgh Pediatric Brain Injury Score is one such tool that would benefit from a multi-center implementation analysis within a child abuse research network (Berger et al, 2016). This specific example highlights the need for a new high-quality child abuse network, such as CAPNET, to address important unanswered questions in child abuse research.…”

Improving Clinical Judgment in Abuse Case Finding

“…Histories in children with acute head trauma are often absent; a feeding and smiling infant in the first year of life, with no neurologic abnormalities on exam, may still have a thin layer subdural hematoma and radiologic evidence of abuse. 9 In the Berger et al study, 2 cases and controls were classified by intracranial findings and selected from 3 different clinical centers. The gold standard for determining trauma was clear-cut and unequivocal.…”