External validation of the PediBIRN clinical prediction rule for abusive head trauma

Background and Objectives: A 4-variable abusive head trauma (AHT) clinical prediction rule (CPR) for use in the Pediatric Intensive Care Unit (PICU) was derived and validated for children <3 years by the Pediatric Brain Injury Research Network (PediBIRN). We set out to externally validate PediBIRN as designed (PICU only), and using broader inclusion criteria (admitted children with head injuries (HIs)). Methods: Secondary analysis of a prospective multicenter study of pediatric HIs of patients with possible AHT at five Australian and New Zealand tertiary pediatric centers. Possible AHT was identified by clinician suspicion, epidemiology codes or a high-risk group (<3 years, admitted, abnormal neuroimaging). At one center we additionally reviewed HIs in the forensic database. We assigned cases as AHT positive, negative or indeterminate following multidisciplinary review and applied the PediBIRN CPR, blinded to outcome, to two populations; PICU admissions only and any HI admissions. CPR accuracy was calculated with 95% confidence intervals. Results: 176 cases