Optimizing targeted, equitable use of neuroimaging in cases of suspected infant physical abuse

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PROJECT SUMMARY/ABSTRACT The purpose of this Career Development Award is to prepare Dr. Maria Kate Henry, MD, MSCE for her long- term goal to serve as an independent clinical investigator developing evidence-based clinical decision support that optimizes the equitable use of imaging to inform the identification, care, and protection of victims of child abuse. Infants with identified injuries that raise concerns regarding potential abuse (e.g., femur fracture) can also have brain injuries that are clinically occult and only detectable by neuroimaging (computed tomography, magnetic resonance imaging). Detection of a clinically occult head injury (e.g., subdural hematoma) guides medical care, dramatically increases the level of diagnostic certainty regarding abuse, and informs child protection decision making. Neuroimaging, however, is not without risk, forcing clinicians to weigh the risks of missing an intracranial injury with the risks of radiation or sedation. While clinicians have clear guidance on use of plain radiography to detect occult fractures when abuse is suspected, they lack clear guidance on use of neuroimaging, contributing to variation and disparities in care. In the proposed study, Dr. Henry will develop the Child Abuse Pediatrics Risk of Intra-Cranial Injury (CAPRICI) clinical decision rule (CDR) that identifies which well-appearing infants with concern for abuse warrant neuroimaging. Specifically in Aim 1, Dr. Henry will use a machine learning approach to adapt and improve a predictive model quantifying risk of intracranial injury among infants undergoing evaluations for abuse in CAPNET, a multicenter child abuse research network. In Aim 2, Dr. Henry will use the RAND/UCLA Appropriateness Method to determine the thresholds at which screening for intracranial injury is warranted based on the probability of injury identification. Based on the findings from Aims 1 and 2, Dr. Henry will create a clinically-informed CAPRICI CDR. This proposal and Dr. Henry’s long-term goals align squarely with AHRQ’s mission of producing evidence to make health care safer, higher quality, and equitable, as well as AHRQ’s research priority of “harnessing data and technology to improve health care quality” in an AHRQ priority population (children). Towards Dr. Henry’s goal of becoming an independent clinical investigator, she and her mentors have developed a comprehensive 5-year career development plan that integrates with the research proposal to ensure that Dr. Henry develops skills in (1) rigorous analysis of multicenter data, (2) CDR development and implementation, (3) modified consensus methodology, and (4) professional development (grant writing, mentorship, presentation, and leadership skills). This plan includes tailored mentorship from local and national leaders, formal didactics, professional development, and an innovative research approach. At the conclusion of this award, Dr. Henry will be well- positioned to apply for a multicenter R01 assessing the impact of implementation of the CDR on clinical practice in CAPNET.