Clinical prediction rules for abusive head trauma: a systematic review

Objective: Misdiagnosis of abusive head trauma (AHT) has serious consequences for children and families. This systematic review identifies and compares clinical prediction rules (CPredRs) assisting clinicians in assessing suspected AHT. Design: We searched MEDLINE, Embase, PubMed and Cochrane databases (January 1996–August 2016). Externally validated CPredRs focusing on the detection of AHT in the clinical setting were included. Results: Of 110 potential articles identified, three studies met the inclusion criteria: the Pediatric Brain Injury Research Network (PediBIRN) 4-Variable AHT CPredR, the Predicting Abusive Head Trauma (PredAHT) tool and the Pittsburgh Infant Brain Injury Score (PIBIS). The CPredRs were designed for different populations and purposes; PediBIRN: intensive care unit admissions (<3 years) with head injury, to inform early decisions to launch or forego an evaluation for abuse (sensitivity 0.96), PredAHT: hospital admissions (<3 years) with intracranial injury, to assist clinicians in discussions with child abuse specialists (sensitivity 0.72), and PIBIS: well-appearing children (<1 year) in the emergency department with no history of trauma, temperature