Estimating the Relevance of Historical Red Flags in the Diagnosis of Abusive Head Trauma

Pediatric Brain Injury Research Network (PediBIRN) Investigators

Research output: Contribution to journalArticlepeer-review

10 Scopus 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.

Original languageEnglish (US)
Pages (from-to)178-183.e2
JournalJournal of Pediatrics
Volume218
DOIs
StatePublished - Mar 2020

Bibliographical note

Funding Information:
Supported by Dartmouth-Hitchcock Medical Center, a private family foundation, The Gerber Foundation, Penn State University, Penn State Health Milton S. Hershey Medical Center, and the National Institutes of Health (P50HD089922). These funding organizations had no role in the study design; the collection, analysis, and interpretation of the data; the writing of the report; and the decision to submit the manuscript for publication. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflicts of interest.

Publisher Copyright:
© 2019 Elsevier Inc.

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