• Kent P Hymel, Veronica Armijo-Garcia, Robin Foster, Terra N Frazier, Michael Stoiko, LeeAnn M Christie, Nancy S Harper, Kerri Weeks, Christopher L Carroll, Phil Hyden, Andrew Sirotnak, Edward Truemper, Amy E Ornstein, Ming Wang, and Pediatric Brain Injury Research Network (PediBIRN) Investigators.
• Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Departments of Pediatrics, and kphymel@gmail.com.
• Pediatrics. 2014 Dec 1;134(6):e1537-44.

Background And ObjectiveTo reduce missed cases of pediatric abusive head trauma (AHT), Pediatric Brain Injury Research Network investigators derived a 4-variable AHT clinical prediction rule (CPR) with sensitivity of .96. Our objective was to validate the screening performance of this AHT CPR in a new, equivalent patient population.MethodsWe conducted a prospective, multicenter, observational, cross-sectional study. Applying the same inclusion criteria, definitional criteria for AHT, and methods used in the completed derivation study, Pediatric Brain Injury Research Network investigators captured complete clinical, historical, and radiologic data on 291 acutely head-injured children <3 years of age admitted to PICUs at 14 participating sites, sorted them into comparison groups of abusive and nonabusive head trauma, and measured the screening performance of the AHT CPR.ResultsIn this new patient population, the 4-variable AHT CPR demonstrated sensitivity of .96, specificity of .46, positive predictive value of .55, negative predictive value of .93, positive likelihood ratio of 1.67, and negative likelihood ratio of 0.09. Secondary analysis revealed that the AHT CPR identified 98% of study patients who were ultimately diagnosed with AHT.ConclusionsFour readily available variables (acute respiratory compromise before admission; bruising of the torso, ears, or neck; bilateral or interhemispheric subdural hemorrhages or collections; and any skull fractures other than an isolated, unilateral, nondiastatic, linear, parietal fracture) identify AHT with high sensitivity in young, acutely head-injured children admitted to the PICU.Copyright © 2014 by the American Academy of Pediatrics.

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