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

项目总结/摘要 这个职业发展奖的目的是准备博士玛丽亚凯特亨利，医学博士，微软首席执行官为她的长期- 长期目标是作为一名独立的临床研究者，开发基于证据的临床决策支持 优化成像的公平使用，为儿童受害者的识别、护理和保护提供信息， 虐待婴儿有确定的伤害，引起对潜在虐待的关注（例如，股骨骨折）可以 也具有临床上隐匿的并且仅通过神经成像（计算机断层扫描， 磁共振成像）。检测临床隐匿性头部损伤（例如，硬膜下血肿）指南 医疗保健，大大提高了对虐待的诊断确定性水平，并告知儿童 保护决策。然而，神经影像学并非没有风险，迫使临床医生权衡 忽略了有放射或镇静风险的颅内损伤。虽然临床医生有明确的使用指南， 当怀疑滥用时，平片X光检查检测隐匿性骨折，他们缺乏明确的指导， 神经影像学，有助于护理的变化和差异。在拟议的研究中，亨利博士将开发 儿童虐待儿童颅内损伤风险（CAPRICI）临床决策规则（CDR），确定 担心被虐待的外表良好的婴儿需要神经成像。特别是在目标1中，亨利博士将使用 采用机器学习方法调整和改进量化颅内损伤风险的预测模型 CAPNET是一个多中心的儿童虐待研究网络。在 目标2，亨利博士将使用兰德/加州大学洛杉矶分校适当方法确定阈值， 基于损伤识别的可能性，有必要对颅内损伤进行筛查。基于 根据目标1和2的发现，亨利博士将创建一个临床知情的CAPRICI CDR。这一建议和博士。 亨利的长期目标与AHRQ的使命完全一致，即提供证据以使医疗保健更安全， 更高的质量，公平，以及AHRQ的研究重点“利用数据和技术， 提高AHRQ重点人群（儿童）的保健质量。朝着亨利博士的目标 作为一名独立的临床研究者，她和她的导师已经发展了一个全面的5年职业生涯， 与研究提案相结合的发展计划，以确保亨利博士在（1）方面发展技能 多中心数据的严格分析，（2）CDR开发和实施，（3）修改共识 方法，和（4）专业发展（赠款写作，导师，演讲和领导技能）。 该计划包括由地方和国家领导人提供量身定制的指导，正式的教学法，专业的 发展和创新的研究方法。在这个奖项结束时，亨利博士将很好- 定位于申请多中心R 01，评估实施CDR对临床 在CAPNET中练习。

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.