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Validation of the PredAHT-2 prediction tool for abusive head trauma
  1. Helena Pfeiffer1,2,
  2. Laura Elizabeth Cowley3,
  3. Alison Mary Kemp3,
  4. Stuart R Dalziel4,5,
  5. Anne Smith6,
  6. John Alexander Cheek1,2,
  7. Meredith L Borland7,8,
  8. Sharon O'Brien7,
  9. Megan Bonisch4,
  10. Jocelyn Neutze9,
  11. Ed Oakley1,2,10,
  12. Louise M Crowe11,
  13. Stephen Hearps11,
  14. Mark D Lyttle12,13,
  15. Silvia Bressan2,14,
  16. Franz E Babl1,2
  1. 1Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia
  2. 2Emergency Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  3. 3Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, South Glamorgan, UK
  4. 4Emergency Department, Starship Children's Health, Auckland, New Zealand
  5. 5Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
  6. 6Victorian Forensic Paediatric Medical Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
  7. 7Department of Emergency Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
  8. 8Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
  9. 9Department of Emergency Medicine, Kidzfirst Middlemore Hospital, Otahuhu, New Zealand
  10. 10School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
  11. 11Department of Child Neuropsychology, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
  12. 12Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
  13. 13Academic Department of Emergency Care, University of the West of England, Bristol, Avon, UK
  14. 14Department of Pediatrics and Child Health, University of Padova, Padova, Italy
  1. Correspondence to Professor Franz E Babl, Emergency Department, Royal Childrens Hospital, Parkville, VC 3052, Australia; franz.babl{at}rch.org.au

Abstract

Objective The validated Predicting Abusive Head Trauma (PredAHT) clinical prediction tool calculates the probability of abusive head trauma (AHT) in children <3 years of age who have sustained intracranial injuries (ICIs) identified on neuroimaging, based on combinations of six clinical features: head/neck bruising, seizures, apnoea, rib fracture, long bone fracture and retinal haemorrhages. PredAHT version 2 enables a probability calculation when information regarding any of the six features is absent. We aimed to externally validate PredAHT-2 in an Australian/New Zealand population.

Methods This is a secondary analysis of a prospective multicentre study of paediatric head injuries conducted between April 2011 and November 2014. We extracted data on patients with possible AHT at five tertiary paediatric centres and included all children <3 years of age admitted to hospital who had sustained ICI identified on neuroimaging. We assigned cases as positive for AHT, negative for AHT or having indeterminate outcome following multidisciplinary review. The estimated probability of AHT for each case was calculated using PredAHT-2, blinded to outcome. Tool performance measures were calculated, with 95% CIs.

Results Of 87 ICI cases, 27 (31%) were positive for AHT; 45 (52%) were negative for AHT and 15 (17%) had indeterminate outcome. Using a probability cut-off of 50%, excluding indeterminate cases, PredAHT-2 had a sensitivity of 74% (95% CI 54% t o89%) and a specificity of 87% (95% CI 73% to 95%) for AHT. Positive predictive value was 77% (95% CI 56% to 91%), negative predictive value was 85% (95% CI 71% to 94%) and the area under the curve was 0.80 (95% CI 0.68 to 0.92).

Conclusion PredAHT-2 demonstrated reasonably high point sensitivity and specificity when externally validated in an Australian/New Zealand population. Performance was similar to that in the original validation study.

Trial registration number ACTRN12614000463673.

  • trauma, head
  • non accidental injury
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Footnotes

  • Twitter @mdlyttle

  • Contributors HP: contributed to the design of the study, conducted the review of medical records, carried out the initial analyses, drafted the initial manuscript and revised the article. LEC: contributed to the design of the study, made substantial contributions to the interpretation and discussion of findings and the drafting of the manuscript, produced figure 2 and critically revised the manuscript for important intellectual content. AMK, JAC, SRD, MLB, SO, MB, JN, EO, LMC, MDL and SB contributed to the design of the study, made substantial contributions to the interpretation and discussion of findings and critically revised the manuscript for important intellectual content. AS: contributed to the design of the study, supervised the categorisation of cases and critically revised the manuscript for important intellectual content. SH: contributed to the design of the study, carried out the initial analyses, drafted the tables and critically revised the manuscript for important intellectual content. FEB: had the initial study idea, contributed to the design of the study and critically revised the manuscript for important intellectual content. He takes responsibility for the paper as a whole.

  • Funding The study was funded by grants from the National Health and Medical Research Council (project grant GNT1046727, Centre of Research Excellence for Paediatric Emergency Medicine GNT1058560), Canberra, Australia; the Murdoch Children’s Research Institute, Melbourne, Australia; the Emergency Medicine Foundation (EMPJ-11162), Brisbane, Australia; Perpetual Philanthropic Services (2012/1140), Australia; Auckland Medical Research Foundation (No. 3112011) and the A + Trust (Auckland District Health Board), Auckland, New Zealand; WA Health Targeted Research Funds 2013, Perth, Australia; the Townsville Hospital and Health Service Private Practice Research and Education Trust Fund, Townsville, Australia; and supported by the Victorian Government’s Infrastructure Support Program, Melbourne, Australia. FEB’s time was part funded by a grant from the Royal Children’s Hospital Foundation and the Melbourne Campus Clinician Scientist Fellowship, Melbourne, Australia, and an NHMRC Practitioner Fellowship, Canberra, Australia. SD’s time was part funded by the Health Research Council of New Zealand (HRC13/556).

  • Competing interests AMK and LEC are part of the team that derived and validated the Predicting Abusive Head Trauma tool. However, all data collection and analyses were undertaken independently of either of these authors.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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