Implementation Trial of a Validated Clinical Decision Rule for Pediatric Abusive Head Trauma (P50 HD089922)
To increase the accuracy of doctors’ decisions to launch or forgo child abuse evaluations in their young, acutely head-injured patients, Pediatric Brain Injury Research Network (PediBIRN) investigators derived and validated a 4-variable clinical decision rule (CDR) that detects abusive head trauma (AHT) with 96% sensitivity in pediatric intensive care unit (PICU) settings. Applied at PICU admission as an AHT screening tool, the CDR categorizes young, acutely head-injured patients as high risk vs. low risk, and recommends thorough abuse evaluations for all high risk patients.
Our ‘CDR Implementation Trial’ across eight PICUs will assess the CDR’s actual impact on AHT screening accuracy. Our ‘stratified cluster randomized trial’ design will facilitate direct comparison of child abuse evaluations at four, randomly selected, control sites to four matched intervention sites, where we will deploy active, multifaceted, implementation strategies designed to promote CDR acceptability and application. Based on our strong Preliminary Studies, we predict that CDR adoption as an AHT screening tool will increase AHT detection; reduce overall abuse evaluations and their associated risks; reduce unwarranted variation in current AHT screening practices; minimize the adverse impacts of doctors’ inherent biases, uncertainty, and practice disparities; reduce AHT-associated acute health care costs in PICU settings; and save the lives of children who will be reinjured and killed if their AHT is missed or unrecognized.
Child Abuse Pediatrician, Penn State Health Children’s Hospital
Professor of Pediatrics, Penn State College of Medicine