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Validation of the Pittsburgh Infant Brain Injury Score for Abusive Head Trauma
Rachel Pardes Berger1, Janet Fromkin2, Bruce Herman3
1Departments of Pediatrics, Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; rachel.berger@chp.edu.
Insights
The Pittsburgh Infant Brain Injury Score (PIBIS) aids in identifying infants needing head computed tomography (CT) scans for suspected abusive head trauma. This validated score helps reduce misdiagnosis and improve outcomes for infants with potential brain injuries.
Area of Science:
- Pediatric neurology
- Medical diagnostics
- Clinical prediction rules
Background:
- Abusive head trauma is a leading cause of infant death due to physical abuse.
- Misdiagnosis of abusive head trauma and other infant brain abnormalities is common, increasing morbidity and mortality.
- The Pittsburgh Infant Brain Injury Score (PIBIS) was developed to aid physicians in identifying high-risk infants for head CT scans.
Purpose of the Study:
- To validate the Pittsburgh Infant Brain Injury Score (PIBIS) in a prospective, multicenter cohort.
- To assess the accuracy of the PIBIS in identifying infants with brain abnormalities requiring neuroimaging.
- To provide a tool for objective decision-making in suspected infant head trauma cases.
Main Methods:
- Prospective, multicenter validation study of well-appearing infants aged 30 to 364 days.
- Inclusion criteria: temperature <38.3°C, no trauma history, and symptoms indicating potential brain abnormality risk.
- Neuroimaging used to classify subjects as cases (brain abnormality) or controls; PIBIS performance metrics (sensitivity, specificity) calculated.
Main Results:
- 1040 infants enrolled (214 cases, 826 controls).
- The 5-point PIBIS includes: dermatologic abnormality (2 pts), age ≥3 months (1 pt), head circumference >85th percentile (1 pt), and serum hemoglobin <11.2 g/dL (1 pt).
- At a PIBIS score of 2, sensitivity for abnormal neuroimaging was 93.3% and specificity was 53%.
Conclusions:
- The PIBIS demonstrates accuracy in identifying infants who would benefit from neuroimaging for suspected brain injury.
- Further implementation analysis is required before widespread clinical adoption of the PIBIS.
- The PIBIS has the potential to improve diagnostic accuracy and reduce unnecessary procedures in evaluating infant head trauma.
Background:
Abusive head trauma is the leading cause of death from physical abuse. Misdiagnosis of abusive head trauma as well as other types of brain abnormalities in infants is common and contributes to increased morbidity and mortality. We previously derived the Pittsburgh Infant Brain Injury Score (PIBIS), a clinical prediction rule to assist physicians deciding which high-risk infants should undergo computed tomography of the head.
Methods:
Well-appearing infants 30 to 364 days of age with temperature <38.3°C, no history of trauma, and a symptom associated with an increased risk of having a brain abnormality were eligible for enrollment in this prospective, multicenter clinical prediction rule validation. By using a predefined neuroimaging paradigm, subjects were classified as cases or controls. The sensitivity, specificity, and negative and positive predictive values of the rule for prediction of brain injury were calculated.
Results:
A total of 1040 infants were enrolled: 214 cases and 826 controls. The 5-point PIBIS included abnormality on dermatologic examination (2 points), age ≥3.0 months (1 point), head circumference >85th percentile (1 point), and serum hemoglobin <11.2g/dL (1 point). At a score of 2, the sensitivity and specificity for abnormal neuroimaging was 93.3% (95% confidence interval 89.0%-96.3%) and 53% (95% confidence interval 49.3%-57.1%), respectively.
Conclusions:
Our data suggest that the PIBIS accurately identifies infants who would benefit from neuroimaging to evaluate for brain injury. An implementation analysis is needed before the PIBIS can be integrated into clinical practice.
