Faculty Collaboration Database

Estimating the Relevance of Historical Red Flags in the Diagnosis of Abusive Head Trauma. J Pediatr 2020 Mar;218:178-183.e2

Date

01/14/2020

Pubmed ID

31928799

Pubmed Central ID

PMC7042052

DOI

10.1016/j.jpeds.2019.11.010

Scopus ID

2-s2.0-85077699885 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

OBJECTIVE: To replicate the previously published finding that the absence of a history of trauma in a child with obvious traumatic head injuries demonstrates high specificity and high positive predictive value (PPV) for abusive head trauma.

STUDY DESIGN: This was a secondary analysis of a deidentified, cross-sectional dataset containing prospective data on 346 young children with acute head injury hospitalized for intensive care across 18 sites between 2010 and 2013, to estimate the diagnostic relevance of a caregiver's specific denial of any trauma, changing history of accidental trauma, or history of accidental trauma inconsistent with the child's gross motor skills. Cases were categorized as definite or not definite abusive head trauma based solely on patients' clinical and radiologic findings. For each presumptive historical "red flag," we calculated sensitivity, specificity, predictive values, and likelihood ratio (LR) with 95% CI for definite abusive head trauma in all patients and also in cohorts with normal, abnormal, or persistent abnormal neurologic status.

RESULTS: A caregiver's specific denial of any trauma demonstrated a specificity of 0.90 (95% CI, 0.84-0.94), PPV of 0.81 (95% CI, 0.71-0.88), and a positive LR (LR+) of 4.83 (95% CI, 3.07-7.61) for definite abusive head trauma in all patients. Specificity and LR+ were lowest-not highest-in patients with persistent neurologic abnormalities. The 2 other historical red flags showed similar trends.

CONCLUSIONS: A caregiver's specific denial of any trauma, changing history of accidental trauma, or history of accidental trauma that is developmentally inconsistent are each highly specific (>0.90) but may provide weaker support than previously reported for a diagnosis of abusive head trauma in patients with persistent neurologic abnormalities.

Author List

Hymel KP, Lee G, Boos S, Karst WA, Sirotnak A, Haney SB, Laskey A, Wang M, Pediatric Brain Injury Research Network (PediBIRN) Investigators

Author

Sandeep K. Narang MD, JD Chief, Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Brain Injuries
Caregivers
Child
Child Abuse
Child, Preschool
Craniocerebral Trauma
Cross-Sectional Studies
Data Interpretation, Statistical
Female
Hospitalization
Humans
Infant
Infant, Newborn
Male
Motor Skills
Predictive Value of Tests
Retrospective Studies
Sensitivity and Specificity