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Validation of the PredAHT-2 prediction tool for abusive head trauma
Helena Pfeiffer1,2, Laura Elizabeth Cowley3, Alison Mary Kemp3
1Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia.
Insights
The Predicting Abusive Head Trauma (PredAHT) tool version 2 shows good accuracy in identifying abusive head trauma (AHT) in young children in Australia and New Zealand. This external validation confirms its clinical utility for diagnosing AHT in pediatric head injuries.
Area of Science:
- Pediatric medicine
- Forensic pathology
- Clinical prediction tools
Background:
- Abusive Head Trauma (AHT) is a serious concern in young children.
- The Predicting Abusive Head Trauma (PredAHT) clinical prediction tool aids in assessing AHT probability.
- PredAHT version 2 accommodates missing clinical data for improved usability.
Purpose of the Study:
- To externally validate the PredAHT version 2 tool.
- To assess PredAHT-2 performance in an Australian/New Zealand pediatric population.
- To confirm the tool's reliability in identifying abusive head trauma.
Main Methods:
- Secondary analysis of a prospective multicentre study on pediatric head injuries.
- Inclusion of children <3 years with intracranial injuries (ICIs) on neuroimaging.
- Calculation of AHT probability using PredAHT-2, blinded to outcome, followed by performance measure analysis.
Main Results:
- Out of 87 ICI cases, 27 (31%) were positive for AHT.
- PredAHT-2 achieved a sensitivity of 74% and specificity of 87% for AHT at a 50% probability cutoff.
- Area under the curve (AUC) was 0.80, indicating good discriminative ability.
Conclusions:
- PredAHT-2 demonstrated good sensitivity and specificity in an Australian/New Zealand population.
- The tool's performance in this external validation was comparable to its original validation.
- PredAHT-2 is a valuable tool for assessing the probability of AHT in pediatric head injuries.
Objective:
The validated Predicting Abusive Head Trauma (PredAHT) clinical prediction tool calculates the probability of abusive head trauma (AHT) in children <3 years of age who have sustained intracranial injuries (ICIs) identified on neuroimaging, based on combinations of six clinical features: head/neck bruising, seizures, apnoea, rib fracture, long bone fracture and retinal haemorrhages. PredAHT version 2 enables a probability calculation when information regarding any of the six features is absent. We aimed to externally validate PredAHT-2 in an Australian/New Zealand population.
Methods:
This is a secondary analysis of a prospective multicentre study of paediatric head injuries conducted between April 2011 and November 2014. We extracted data on patients with possible AHT at five tertiary paediatric centres and included all children <3 years of age admitted to hospital who had sustained ICI identified on neuroimaging. We assigned cases as positive for AHT, negative for AHT or having indeterminate outcome following multidisciplinary review. The estimated probability of AHT for each case was calculated using PredAHT-2, blinded to outcome. Tool performance measures were calculated, with 95% CIs.
Results:
Of 87 ICI cases, 27 (31%) were positive for AHT; 45 (52%) were negative for AHT and 15 (17%) had indeterminate outcome. Using a probability cut-off of 50%, excluding indeterminate cases, PredAHT-2 had a sensitivity of 74% (95% CI 54% t o89%) and a specificity of 87% (95% CI 73% to 95%) for AHT. Positive predictive value was 77% (95% CI 56% to 91%), negative predictive value was 85% (95% CI 71% to 94%) and the area under the curve was 0.80 (95% CI 0.68 to 0.92).
Conclusion:
PredAHT-2 demonstrated reasonably high point sensitivity and specificity when externally validated in an Australian/New Zealand population. Performance was similar to that in the original validation study.
Trial Registration Number:
ACTRN12614000463673.
