Screening for pediatric abusive head trauma: Are three variables enough?
Screening for pediatric abusive head trauma: Are three variables enough?
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儿童虐待性头部外伤的筛查：三个变量就足够了吗？
DOI：
10.1016/j.chiabu.2022.105518
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发表时间：
2022-03
影响因子：
4.8
通讯作者：
Pediatric Brain Injury Research Network (PediBIRN) Investigators
中科院分区：
文献类型：
--
作者：
Hymel KP;Karst W;Marinello M;Herman BE;Frazier TN;Carroll CL;Armijo-Garcia V;Musick M;Weeks K;Haney SB;Pashai A;Wang M;Pediatric Brain Injury Research Network (PediBIRN) Investigators
PediBIRN 4 变量临床决策规则 (CDR) 在儿科重症监护 (PICU) 环境中以 96% 的灵敏度检测虐待性头部创伤 (AHT)。对其在儿科急诊科环境中的表现的初步分析发现，消除第四个预测变量提高了筛查准确性。比较 PICU 设置中“PediBIRN-4”CDR 与简化的 3 变量 CDR 的 AHT 筛查性能。 2011 年 2 月至 2021 年 3 月期间，973 名 3 岁以下的急性头部受伤儿童在 18 个地点住院接受重症监护。对合并的前瞻性 PediBIRN 数据集进行回顾性二次分析。反复应用 AHT 定义标准和医生的诊断，将患者分为虐待组和其他头部外伤组。 CDR 表现的结果指标包括敏感性、特异性、预测值、似然比、ROC AUC 以及每个 CDR 的 AHT 概率的患者特异性估计与患者已完成的滥用评估的总体阳性率之间的相关性。如果准确且一致地应用，两种 CDR 的敏感性均≥93%，阴性预测值≥91%。消除 PediBIRN-4 的第四个预测变量会导致显着更高的特异性 (↑’d ≥19%)、阳性预测值 (↑’d ≥8%) 和 ROCAUC (↑’d ≥5%)，但敏感性降低 3%。两个 CDR 都提供了针对患者的滥用概率估计值，与患者完成的滥用评估的正值密切相关（Pearson 的 r = .95 和 .91，p = .13）。 PediBIRN 3 变量 CDR 的 AHT 筛选精度高于 4 变量 CDR。两者都是患者随后完成的滥用评估结果的良好预测指标。
The PediBIRN 4-variable clinical decision rule (CDR) detects abusive head trauma (AHT) with 96% sensitivity in pediatric intensive care (PICU) settings. Preliminary analysis of its performance in Pediatric Emergency Department settings found that elimination of its fourth predictor variable enhanced screening accuracy. To compare the AHT screening performances of the “PediBIRN-4” CDR vs. the simplified 3-variable CDR in PICU settings. 973 acutely head-injured children <3 years hospitalized for intensive care across 18 sites between February 2011 and March 2021. Retrospective, secondary analysis of the combined, prospective PediBIRN data sets. AHT definitional criteria and physicians’ diagnoses were applied iteratively to sort patients into abusive vs. other head trauma cohorts. Outcome measures of CDR performance included sensitivity, specificity, predictive values, likelihood ratios, ROC AUC, and the correlation between each CDR’s patient-specific estimates of AHT probability and the overall positive yield of patients’ completed abuse evaluations. Applied accurately and consistently, both CDR’s would have performed with sensitivity ≥93% and negative predictive value ≥91%. Eliminating the PediBIRN-4’s fourth predictor variable resulted in significantly higher specificity (↑’d ≥19%), positive predictive value (↑’d ≥8%), and ROC AUC (↑’d ≥5%), but a 3% reduction in sensitivity. Both CDRs provided patient-specific estimates of abuse probability very strongly correlated with the positive yield of patients’ completed abuse evaluations (Pearson’s r =.95 and .91, p =.13). The PediBIRN 3-variable CDR performed with greater AHT screening accuracy than the 4-variable CDR. Both are good predictors of the results of patients’ subsequent completed abuse evaluations.
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影响因子：
8
作者：
Hymel, Kent P.;Armijo-Garcia, Veronica;Wang, Ming
通讯作者：
Wang, Ming
影响因子：
4.1
作者：
Hymel, Kent P.;Willson, Douglas F.;Narang, Sandeep K.
通讯作者：
Narang, Sandeep K.
影响因子：
8
作者：
Pfeiffer, Helena;Smith, Anne;Babl, Franz E.
通讯作者：
Babl, Franz E.
DOI：
10.1016/j.jpeds.2021.03.055
发表时间：
2021-09
期刊：
The Journal of pediatrics
影响因子：
--
作者：
Hymel KP;Armijo-Garcia V;Musick M;Marinello M;Herman BE;Weeks K;Haney SB;Frazier TN;Carroll CL;Kissoon NN;Isaac R;Foster R;Campbell KA;Tieves KS;Livingston N;Bucher A;Woosley MC;Escamilla-Padilla D;Jaimon N;Kustka L;Wang M;Chinchilli VM;Dias MS;Noll J;Pediatric Brain Injury Research Network (PediBIRN) Investigators
通讯作者：
Pediatric Brain Injury Research Network (PediBIRN) Investigators
影响因子：
4.8
作者：
Hymel, Kent P.;Wang, Ming;Hyden, Phil
通讯作者：
Hyden, Phil