A Cluster Randomized Trial to Reduce Missed Abusive Head Trauma in Pediatric Intensive Care Settings.
A Cluster Randomized Trial to Reduce Missed Abusive Head Trauma in Pediatric Intensive Care Settings.
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DOI：
10.1016/j.jpeds.2021.03.055
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Pediatric Brain Injury Research Network (PediBIRN) Investigators
中科院分区：
文献类型：
--
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
To estimate the impact of the PediBIRN (Pediatric Brain Injury Research Network) 4-variable clinical decision rule (CDR) on abuse evaluations and missed abusive head trauma in pediatric intensive care settings. Cluster randomized trial. Participants were 8 pediatric intensive care units (PICUs) in US academic medical centers; PICU and child abuse physicians; and consecutive acutely head-injured patients <3 years (n=183 and n=237, intervention vs. control). PICUs were stratified by patient volumes, pair matched, and randomized equally to intervention or control conditions. Randomization was concealed from the biostatistician. Physician-directed, cluster level interventions included initial and booster training, an abusive head trauma probability calculator, and information sessions. Outcomes included “higher risk” patients evaluated thoroughly for abuse (with skeletal survey and retinal examination), potential cases of missed abusive head trauma (patients lacking either evaluation), and estimates of missed abusive head trauma (among potential cases). Group comparisons were performed using generalized linear mixed-effects models. Intervention physicians evaluated a greater proportion of higher risk patients thoroughly (81% vs. 73%, P=. 11) and had fewer potential cases of missed abusive head trauma (21% vs. 32%, P=.05), although estimated cases of missed abusive head trauma did not differ (7% vs 13%, P=.22). From baseline (in prior studies) to trial, the change in higher risk patients evaluated thoroughly (67%→81% vs. 78%→73%, P=.01), and potential cases of missed abusive head trauma (40%→21% vs. 29%→32%, P=.003), diverged significantly. We did not identify a significant change in the number of estimated cases of missed abusive head trauma (15%→7% vs. 11%→13%, P=.22). PediBIRN-4 CDR application facilitated changes in evaluations that reduced potential cases of missed abusive head trauma in PICU settings. ClinicalTrials.gov: NCT03162354
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影响因子：
8
作者：
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通讯作者：
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影响因子：
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