Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, United States.
Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.
Child Abuse Negl. 2019 Feb;88:266-274. doi: 10.1016/j.chiabu.2018.11.015. Epub 2018 Dec 11.
Evidence-based, patient-specific estimates of abusive head trauma probability can inform physicians' decisions to evaluate, confirm, exclude, and/or report suspected child abuse.
To derive a clinical prediction rule for pediatric abusive head trauma that incorporates the (positive or negative) predictive contributions of patients' completed skeletal surveys and retinal exams.
500 acutely head-injured children under three years of age hospitalized for intensive care at one of 18 sites between 2010 and 2013.
Secondary analysis of an existing, cross-sectional, prospective dataset, including (1) multivariable logistic regression to impute the results of abuse evaluations never ordered or completed, (2) regularized logistic regression to derive a novel clinical prediction rule that incorporates the results of completed abuse evaluations, and (3) application of the new prediction rule to calculate patient-specific estimates of abusive head trauma probability for observed combinations of its predictor variables.
Applying a mean probability threshold of >0.5 to classify patients as abused, the 7-variable clinical prediction rule derived in this study demonstrated sensitivity 0.73 (95% CI: 0.66-0.79) and specificity 0.87 (95% CI: 0.82-0.90). The area under the receiver operating characteristics curve was 0.88 (95% CI: 0.85-0.92). Patient-specific estimates of abusive head trauma probability for 72 observed combinations of its seven predictor variables ranged from 0.04 (95% CI: 0.02-0.08) to 0.98 (95% CI: 0.96-0.99).
Seven variables facilitate patient-specific estimation of abusive head trauma probability after abuse evaluation in intensive care settings.
基于证据的、针对患者个体的虐待性头部创伤可能性的评估可以为医生提供决策依据，以评估、确认、排除和/或报告疑似儿童虐待的情况。
制定一个包含（阳性或阴性）患者完成的骨骼扫描和视网膜检查的预测贡献的儿科虐待性头部创伤临床预测规则。
2010 年至 2013 年期间，18 个地点之一的重症监护病房中因头部受伤住院的 500 名三岁以下急性颅脑损伤儿童。
对现有、横断面、前瞻性数据集进行二次分析，包括（1）多变量逻辑回归来推断从未下达或完成的虐待评估结果，（2）正则化逻辑回归来推导一个新的临床预测规则，纳入已完成的虐待评估结果，以及（3）应用新的预测规则来计算观察到的其预测变量组合的患者个体的虐待性头部创伤概率估计。
应用平均概率阈值>0.5 将患者分类为虐待性，本研究中得出的 7 变量临床预测规则显示敏感性为 0.73（95%CI：0.66-0.79），特异性为 0.87（95%CI：0.82-0.90）。接收者操作特征曲线下面积为 0.88（95%CI：0.85-0.92）。7 个预测变量的 72 种观察到的组合的患者个体的虐待性头部创伤概率估计值从 0.04（95%CI：0.02-0.08）到 0.98（95%CI：0.96-0.99）不等。
在重症监护环境中进行虐待评估后，七个变量有助于患者个体的虐待性头部创伤概率的估计。
