| Abstract | Physician failures to recognize, diagnose, and report pediatric abusive head trauma (AHT) place young victims at risk for continued abuse. The PediBIRN (Pediatric Brain Injury Research Network) 4-variable clinical decision rule (CDR) recommends thorough abuse evaluations for acutely head-injured patients it designates “higher risk”. Applied accurately and consistently, the CDR should “miss” only 4% of AHT cases. The CDR’s actual impact on missed AHT has not been assessed.
We conducted a cluster randomized trial (CRT) to assess the CDR’s actual impact on missed AHT. Participants were eight U.S. pediatric intensive care units (PICU), PICU and child abuse physicians, and a consecutive sample of their young acutely head-injured patients. PICUs were stratified by projected patient volumes, matched into pairs, and randomly allocated to control (n=4) or intervention (n=4) conditions. Randomization sequences were concealed from the biostatistician assessing outcomes. Interventions and outcomes were applied at the cluster level. Interventions included initial and booster training, an AHT probability calculator, progress reports, and information sessions. At control PICUs, the CRT was strictly observational.
Primary outcome measures included: (1) higher risk patients evaluated thoroughly [with skeletal survey and retinal examination], (2) lower risk patients evaluated even partially [with skeletal survey and/or retinal examination], (3) potential cases of missed AHT [i.e., patients lacking skeletal survey and/or retinal exam], and (4) estimated rates of missed AHT [among potential cases].
This data set includes de-identified individual participant (patient) data and the analytic code used to calculate the primary outcome measures.
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