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External validation of pittsburgh infant brain injury score in a French pediatric study
Cécile Oger1, Audrey Grain2, Elise Launay3
1CHU Nantes, Pediatric emergency department F-44000 Nantes, France.
Insights
The Pittsburgh Infant Brain Injury Score (PIBIS) clinical prediction rule (CPR) showed lower diagnostic accuracy in a French infant population. Further research is needed to improve its performance for diagnosing abusive head trauma (AHT).
Area of Science:
- Pediatric Emergency Medicine
- Neuroimaging
- Clinical Prediction Rules
Background:
- Abusive Head Trauma (AHT) is a significant cause of infant morbidity and mortality.
- Rapid diagnosis and neuroimaging are crucial for infants with suspected AHT.
- The Pittsburgh Infant Brain Injury Score (PIBIS) clinical prediction rule (CPR) was developed to aid in identifying infants needing head CT.
Purpose of the Study:
- To externally validate the diagnostic performance of the PIBIS CPR in a pediatric French population.
- To assess the accuracy of the PIBIS CPR in identifying infants with brain injury, particularly AHT.
Main Methods:
- Retrospective study conducted in a French pediatric emergency department (2015-2017).
- Inclusion of consecutive infants who underwent neurological imaging.
- Collection of medical data and retrospective determination of PIBIS scores.
Main Results:
- 129 infants were included; 33 had brain injury, including 20 with AHT.
- PIBIS CPR sensitivity was 75.8% and specificity was 61.4%.
- Among infants with AHT, 95.0% were correctly identified by the PIBIS CPR.
Conclusions:
- The external validation demonstrated a lower diagnostic value for the PIBIS CPR compared to the original study.
- The findings suggest the need to enhance the PIBIS CPR's performance, potentially by incorporating biomarkers.
- Improved diagnostic tools are essential for suspected cases of abusive head trauma.
Background:
Abusive Head Trauma (AHT) is a leading cause of morbidity and mortality in infants requiring rapid neuroimaging performance and prognostic rapid diagnosis. The Pittsburgh Infant Brain Injury Score (PIBIS) clinical prediction rule (CPR) was derived to identify infants most likely to present brain injury, whose diagnosis would benefit from head CT. Our study aimed to externally validate the PIBIS CPR in a pediatric French population.
Methods:
A retrospective study was conducted in a French pediatric emergency department between 2015 and 2017. We included all consecutive infants who underwent a neurological imaging. Medical data were collected, and PIBIS score was determined, both retrospectively.
Results:
We included 129 infants among which 33 cases (including 20 with a diagnosis of AHT). The sensitivity and specificity of the PIBIS CPR were 75.8 % (95 % CI 57.7-88.9) and 61.4 % (51.0-71.2) and negative and positive predictive values 88.1 % (77.8-94.7) and 40.3 % (33.0-48.2). Among the 20 infants with a diagnosis of AHT, 19 (95.0 %) were correctly identified by the PIBIS CPR.
Conclusion:
Our external validation study found a lower diagnostic value of the PIBIS CPR than in the original study. This argues for adding biomarkers to improve its performance, notably in the context of suspected AHT.
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