Validation of the PredAHT-2 prediction tool for abusive head trauma

Pfeiffer, Helena; Cowley, Laura; Kemp, Alison; Dalziel, Stuart R; Smith, Andrew; Cheek, John A; Borland, Meredith L; O’Brien, Sharon; Bonisch, Megan; Neutze, Jocelyn; Oakley, Ed; Crowe, Louise; Hearps, Stephen; Lyttle, Mark D; Bressan, Silvia; Babl, Franz E

doi:10.1136/emermed-2019-208893

Cited by 10 publications

(6 citation statements)

References 30 publications

(47 reference statements)

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“…The sensitivity of the tool based on a 50% probability cut-off is 72.3% and specificity of 85.7% (77,78). PredAHT-2 was updated to account for missing data, as well as externally validated in an Australian/New Zealand population (79). The Pittsburgh Infant Brain Injury Score (PIBIS) was developed by Berger et al to guide the decision-making process for neuroimaging in otherwise healthy infants presenting to the ED at risk for AHT given symptoms that could be attributed to intracranial pathology in the absence of a trauma history.…”

Section: Clinical Prediction Rulesmentioning

confidence: 99%

Advances and Future Directions of Diagnosis and Management of Pediatric Abusive Head Trauma: A Review of the Literature

2020

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Abusive head trauma (AHT) is broadly defined as injury of the skull and intracranial contents as a result of perpetrator-inflicted force and represents a persistent and significant disease burden in children under the age of 4 years. When compared to age-matched controls with typically single occurrence accidental traumatic brain injury (TBI), mortality after AHT is disproportionately high and likely attributable to key differences between injury phenotypes. This article aims to review the epidemiology of AHT, summarize the current state of AHT diagnosis, treatment, and prevention as well as areas for future directions of study. Despite neuroimaging advances and an evolved understanding of AHT, early identification remains a challenge for contemporary clinicians. As such, the reported incidence of 10-30 per 100,000 infants per year may be a considerable underestimate that has not significantly decreased over the past several decades despite social campaigns for public education such as "Never Shake a Baby." This may reflect caregivers in crisis for whom education is not sufficient without support and intervention, or dangerous environments in which other family members are at risk in addition to the child. Acute management specific to AHT has not advanced beyond usual supportive care for childhood TBI, and prevention and early recognition remain crucial. Moreover, AHT is frequently excluded from studies of childhood TBI, which limits the precise translation of important brain injury research to this population. Repeated injury, antecedent abuse or neglect, delayed medical attention, and high rates of apnea and seizures on presentation are important variables to be considered. More research, including AHT inclusion in childhood TBI studies with comparisons to age-matched controls, and translational models with clinical fidelity are needed to better elucidate the pathophysiology of AHT and inform both clinical care and the development of targeted therapies. Clinical prediction rules, biomarkers, and imaging modalities hold promise, though these have largely been developed and validated in patients after clinically evident AHT has already occurred. Nevertheless, recognition of warning signs and intervention before irreversible harm occurs remains the current best strategy for medical professionals to protect vulnerable infants and toddlers.

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Section: Clinical Prediction Rulesmentioning

confidence: 99%

Advances and Future Directions of Diagnosis and Management of Pediatric Abusive Head Trauma: A Review of the Literature

2020

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“…Thirty‐five imaging‐related recommendations were developed: three adopted, 10 adapted and 22 new; 18 EIRs, five CBRs and 12 PPs (Table 2). A large body of evidence, including Australian and New Zealand studies, 5–7,24,31–36 was available for the key initial decision process in the acute care setting, that is, the question of ‘Which children should undergo head CT?’ Among Australian and New Zealand head injured children, the PECARN CDR was the most accurate in identifying children with clinically important traumatic brain injury, traumatic brain injury on CT and requirement for neurosurgical management 5 . Therefore, the risk factors identified in the PECARN CDR, together with post‐traumatic seizures 37 and abnormal neurological examination (Table 2; Box 1), were used to risk stratify mild and moderate head injured children within the PREDICT Guideline Recommendations and the Guideline Algorithm.…”

Section: Resultsmentioning

confidence: 99%

“…The quality of the evidence to develop imaging guidance for children with underlying ventricular shunts, bleeding disorders, neurodevelopmental disorders, associated conditions such as intoxication, or associated concerns such as abusive head trauma was limited by small sample sizes 31,33,34,40,41 resulting in a greater number of CBRs and PPs (Table 2).…”

Section: Resultsmentioning

confidence: 99%

Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children

Babl

Tavender

Ballard

et al. 2021

Emerg Medicine Australasia

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Objective Children frequently present with head injuries to acute care settings. Although international paediatric clinical practice guidelines for head injuries exist, they do not address all considerations related to triage, imaging, observation versus admission, transfer, discharge and follow‐up of mild to moderate head injuries relevant to the Australian and New Zealand context. The Paediatric Research in Emergency Departments International Collaborative (PREDICT) set out to develop an evidence‐based, locally applicable, practical clinical guideline for the care of children with mild to moderate head injuries presenting to acute care settings. Methods A multidisciplinary Guideline Working Group (GWG) developed 33 questions in three key areas – triage, imaging and discharge of children with mild to moderate head injuries presenting to acute care settings. We identified existing high‐quality guidelines and from these guidelines recommendations were mapped to clinical questions. Updated literature searches were undertaken, and key new evidence identified. Recommendations were created through either adoption, adaptation or development of de novo recommendations. The guideline was revised after a period of public consultation. Results The GWG developed 71 recommendations (evidence‐informed = 35, consensus‐based = 17, practice points = 19), relevant to the Australian and New Zealand setting. The guideline is presented as three documents: (i) a detailed Full Guideline summarising the evidence underlying each recommendation; (ii) a Guideline Summary; and (iii) a clinical Algorithm: Imaging and Observation Decision‐making for Children with Head Injuries. Conclusions The PREDICT Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children provides high‐level evidence and practical guidance for front line clinicians.

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“…However, this serves mainly as a reminder that there is no injury pattern that is pathognomonic for abuse, and providers should put injuries within the context of the reported event and make an effort to rule out underlying conditions or alternative explanations. That said, there are a variety of validated clinical prediction scores that, when used in conjunction with an individual physician's clinical judgment, and consultation by a child abuse expert if available, may help detect the presence of AHT [67,68] (Table 2).…”

Section: Abusive Head Traumamentioning

confidence: 99%

Non-accidental Trauma in Infants: a Review of Evidence-Based Strategies for Diagnosis, Management, and Prevention

et al. 2022

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Purpose of Review To provide a resource for providers that may be involved in the diagnosis and management of infant non-accidental trauma (NAT). Recent Findings Infants are more likely to both suffer from physical abuse and die from their subsequent injuries. There are missed opportunities among providers for recognizing sentinel injuries. Minority children are overrepresented in the reporting of child maltreatment, and there is systemic bias in the evaluation and treatment of minority victims of child abuse. Summary Unfortunately, no single, primary preventative intervention has been conclusively shown to reduce the incidence of child maltreatment. Standardized algorithms for NAT screening have been shown to increase the bias-free utilization of NAT evaluations. Every healthcare provider that interacts with children has a responsibility to recognize warning signs of NAT, be able to initiate the evaluation for suspected NAT, and understand their role as a mandatory reporter.

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Validation of the PredAHT-2 prediction tool for abusive head trauma

Cited by 10 publications

References 30 publications

Advances and Future Directions of Diagnosis and Management of Pediatric Abusive Head Trauma: A Review of the Literature

Advances and Future Directions of Diagnosis and Management of Pediatric Abusive Head Trauma: A Review of the Literature

Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children

Non-accidental Trauma in Infants: a Review of Evidence-Based Strategies for Diagnosis, Management, and Prevention

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