A Cluster Randomized Trial to Reduce Missed Abusive Head Trauma in Pediatric Intensive Care Settings
To estimate the impact of the PediBIRN (Pediatric Brain Injury Research Network) 4-variable clinical decision rule (CDR) on abuse evaluations and missed abusive head trauma in pediatric intensive care settings. This was a cluster randomized trial. Participants included 8 pediatric intensive care uni...
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| Veröffentlicht in: | The Journal of pediatrics 2021-09, Vol.236, p.260-268.e3 |
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| creator | Hymel, Kent P. Armijo-Garcia, Veronica Musick, Matthew Marinello, Mark Herman, Bruce E. Weeks, Kerri Haney, Suzanne B. Frazier, Terra N. Carroll, Christopher L. Kissoon, Natalie N. Isaac, Reena Foster, Robin Campbell, Kristine A. Tieves, Kelly S. Livingston, Nina Bucher, Ashley Woosley, Maria C. Escamilla-Padilla, Dorinda Jaimon, Nancy Kustka, Lucinda Wang, Ming Chinchilli, Vernon M. Dias, Mark S. Noll, Jennie |
| description | To estimate the impact of the PediBIRN (Pediatric Brain Injury Research Network) 4-variable clinical decision rule (CDR) on abuse evaluations and missed abusive head trauma in pediatric intensive care settings.
This was a cluster randomized trial. Participants included 8 pediatric intensive care units (PICUs) in US academic medical centers; PICU and child abuse physicians; and consecutive patients with acute head injures |
| doi_str_mv | 10.1016/j.jpeds.2021.03.055 |
| format | Article |
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This was a cluster randomized trial. Participants included 8 pediatric intensive care units (PICUs) in US academic medical centers; PICU and child abuse physicians; and consecutive patients with acute head injures <3 years (n = 183 and n = 237, intervention vs control). PICUs were stratified by patient volumes, pair-matched, and randomized equally to intervention or control conditions. Randomization was concealed from the biostatistician. Physician-directed, cluster-level interventions included initial and booster training, access to an abusive head trauma probability calculator, and information sessions. Outcomes included “higher risk” patients evaluated thoroughly for abuse (with skeletal survey and retinal examination), potential cases of missed abusive head trauma (patients lacking either evaluation), and estimates of missed abusive head trauma (among potential cases). Group comparisons were performed using generalized linear mixed-effects models.
Intervention physicians evaluated a greater proportion of higher risk patients thoroughly (81% vs 73%, P = .11) and had fewer potential cases of missed abusive head trauma (21% vs 32%, P = .05), although estimated cases of missed abusive head trauma did not differ (7% vs 13%, P = .22). From baseline (in previous studies) to trial, the change in higher risk patients evaluated thoroughly (67%→81% vs 78%→73%, P = .01), and potential cases of missed abusive head trauma (40%→21% vs 29%→32%, P = .003), diverged significantly. We did not identify a significant divergence in the number of estimated cases of missed abusive head trauma (15%→7% vs 11%→13%, P = .22).
PediBIRN-4 CDR application facilitated changes in abuse evaluations that reduced potential cases of missed abusive head trauma in PICU settings.
ClinicalTrials.gov: NCT03162354.</description><identifier>ISSN: 0022-3476</identifier><identifier>EISSN: 1097-6833</identifier><identifier>DOI: 10.1016/j.jpeds.2021.03.055</identifier><identifier>PMID: 33798512</identifier><language>eng</language><publisher>NEW YORK: Elsevier Inc</publisher><subject>Child ; child abuse ; Child Abuse - diagnosis ; clinical decision rule ; Craniocerebral Trauma - diagnosis ; Critical Care ; Humans ; Intensive Care Units, Pediatric ; Life Sciences & Biomedicine ; Mass Screening ; Pediatrics ; Science & Technology ; screening test</subject><ispartof>The Journal of pediatrics, 2021-09, Vol.236, p.260-268.e3</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>10</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000688262300045</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c459t-db050637e2837a06517235b434c6cce718679c2844512ba9b5edbf309eadb9c3</citedby><cites>FETCH-LOGICAL-c459t-db050637e2837a06517235b434c6cce718679c2844512ba9b5edbf309eadb9c3</cites><orcidid>0000-0002-8008-6232 ; 0000-0002-9977-7041</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpeds.2021.03.055$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,315,782,786,887,3552,27931,27932,39264,39265,46002</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33798512$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hymel, Kent P.</creatorcontrib><creatorcontrib>Armijo-Garcia, Veronica</creatorcontrib><creatorcontrib>Musick, Matthew</creatorcontrib><creatorcontrib>Marinello, Mark</creatorcontrib><creatorcontrib>Herman, Bruce E.</creatorcontrib><creatorcontrib>Weeks, Kerri</creatorcontrib><creatorcontrib>Haney, Suzanne B.</creatorcontrib><creatorcontrib>Frazier, Terra N.</creatorcontrib><creatorcontrib>Carroll, Christopher L.</creatorcontrib><creatorcontrib>Kissoon, Natalie N.</creatorcontrib><creatorcontrib>Isaac, Reena</creatorcontrib><creatorcontrib>Foster, Robin</creatorcontrib><creatorcontrib>Campbell, Kristine A.</creatorcontrib><creatorcontrib>Tieves, Kelly S.</creatorcontrib><creatorcontrib>Livingston, Nina</creatorcontrib><creatorcontrib>Bucher, Ashley</creatorcontrib><creatorcontrib>Woosley, Maria C.</creatorcontrib><creatorcontrib>Escamilla-Padilla, Dorinda</creatorcontrib><creatorcontrib>Jaimon, Nancy</creatorcontrib><creatorcontrib>Kustka, Lucinda</creatorcontrib><creatorcontrib>Wang, Ming</creatorcontrib><creatorcontrib>Chinchilli, Vernon M.</creatorcontrib><creatorcontrib>Dias, Mark S.</creatorcontrib><creatorcontrib>Noll, Jennie</creatorcontrib><creatorcontrib>Pediatric Brain Injury Research Network (PediBIRN) Investigators</creatorcontrib><creatorcontrib>Pediat Brain Injury Res Network Pe</creatorcontrib><title>A Cluster Randomized Trial to Reduce Missed Abusive Head Trauma in Pediatric Intensive Care Settings</title><title>The Journal of pediatrics</title><addtitle>J PEDIATR-US</addtitle><addtitle>J Pediatr</addtitle><description>To estimate the impact of the PediBIRN (Pediatric Brain Injury Research Network) 4-variable clinical decision rule (CDR) on abuse evaluations and missed abusive head trauma in pediatric intensive care settings.
This was a cluster randomized trial. Participants included 8 pediatric intensive care units (PICUs) in US academic medical centers; PICU and child abuse physicians; and consecutive patients with acute head injures <3 years (n = 183 and n = 237, intervention vs control). PICUs were stratified by patient volumes, pair-matched, and randomized equally to intervention or control conditions. Randomization was concealed from the biostatistician. Physician-directed, cluster-level interventions included initial and booster training, access to an abusive head trauma probability calculator, and information sessions. Outcomes included “higher risk” patients evaluated thoroughly for abuse (with skeletal survey and retinal examination), potential cases of missed abusive head trauma (patients lacking either evaluation), and estimates of missed abusive head trauma (among potential cases). Group comparisons were performed using generalized linear mixed-effects models.
Intervention physicians evaluated a greater proportion of higher risk patients thoroughly (81% vs 73%, P = .11) and had fewer potential cases of missed abusive head trauma (21% vs 32%, P = .05), although estimated cases of missed abusive head trauma did not differ (7% vs 13%, P = .22). From baseline (in previous studies) to trial, the change in higher risk patients evaluated thoroughly (67%→81% vs 78%→73%, P = .01), and potential cases of missed abusive head trauma (40%→21% vs 29%→32%, P = .003), diverged significantly. We did not identify a significant divergence in the number of estimated cases of missed abusive head trauma (15%→7% vs 11%→13%, P = .22).
PediBIRN-4 CDR application facilitated changes in abuse evaluations that reduced potential cases of missed abusive head trauma in PICU settings.
ClinicalTrials.gov: NCT03162354.</description><subject>Child</subject><subject>child abuse</subject><subject>Child Abuse - diagnosis</subject><subject>clinical decision rule</subject><subject>Craniocerebral Trauma - diagnosis</subject><subject>Critical Care</subject><subject>Humans</subject><subject>Intensive Care Units, Pediatric</subject><subject>Life Sciences & Biomedicine</subject><subject>Mass Screening</subject><subject>Pediatrics</subject><subject>Science & Technology</subject><subject>screening test</subject><issn>0022-3476</issn><issn>1097-6833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>GIZIO</sourceid><sourceid>HGBXW</sourceid><sourceid>EIF</sourceid><recordid>eNqNkdGK1DAUhoso7rj6BILkUpDW06Rp0wuFoai7sKKscx_S5MyaoZOMSTqiT29mZxz0RrxKSL7_5A9fUTyvoaqhbl9vqs0OTawo0LoCVgHnD4pFDX1XtoKxh8UCgNKSNV17UTyJcQMAfQPwuLhgrOsFr-miMEsyTHNMGMitcsZv7U80ZBWsmkjy5BbNrJF8tDHm4-U4R7tHcoXqwKh5q4h15DMaq1Kwmly7hO4eGVRA8gVTsu4uPi0erdUU8dlpvSxW79-thqvy5tOH62F5U-qG96k0I3BoWYdUsE5By-uOMj42rNGt1tjVou16TUXT5Oqj6keOZlwz6HOdsdfssnh7HLubxy0ajS4FNcldsFsVfkivrPz7xtmv8s7vpWiA1YzmAS9PA4L_NmNMcmujxmlSDv0cJeUgeNdD22WUHVEdfIwB1-dnapAHPXIj7_XIgx4JTGY9OfXiz4bnzG8fGRBH4DuOfh21RafxjGWBrRC0pSzvGj7YpJL1bvCzSzn66v-jmX5zpDH72FsM8pQwNqBO0nj7z5_8Ai9Pw5A</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Hymel, Kent P.</creator><creator>Armijo-Garcia, Veronica</creator><creator>Musick, Matthew</creator><creator>Marinello, Mark</creator><creator>Herman, Bruce E.</creator><creator>Weeks, Kerri</creator><creator>Haney, Suzanne B.</creator><creator>Frazier, Terra N.</creator><creator>Carroll, Christopher L.</creator><creator>Kissoon, Natalie N.</creator><creator>Isaac, Reena</creator><creator>Foster, Robin</creator><creator>Campbell, Kristine A.</creator><creator>Tieves, Kelly S.</creator><creator>Livingston, Nina</creator><creator>Bucher, Ashley</creator><creator>Woosley, Maria C.</creator><creator>Escamilla-Padilla, Dorinda</creator><creator>Jaimon, Nancy</creator><creator>Kustka, Lucinda</creator><creator>Wang, Ming</creator><creator>Chinchilli, Vernon M.</creator><creator>Dias, Mark S.</creator><creator>Noll, Jennie</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>17B</scope><scope>BLEPL</scope><scope>DTL</scope><scope>DVR</scope><scope>EGQ</scope><scope>GIZIO</scope><scope>HGBXW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-8008-6232</orcidid><orcidid>https://orcid.org/0000-0002-9977-7041</orcidid></search><sort><creationdate>20210901</creationdate><title>A Cluster Randomized Trial to Reduce Missed Abusive Head Trauma in Pediatric Intensive Care Settings</title><author>Hymel, Kent P. ; 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This was a cluster randomized trial. Participants included 8 pediatric intensive care units (PICUs) in US academic medical centers; PICU and child abuse physicians; and consecutive patients with acute head injures <3 years (n = 183 and n = 237, intervention vs control). PICUs were stratified by patient volumes, pair-matched, and randomized equally to intervention or control conditions. Randomization was concealed from the biostatistician. Physician-directed, cluster-level interventions included initial and booster training, access to an abusive head trauma probability calculator, and information sessions. Outcomes included “higher risk” patients evaluated thoroughly for abuse (with skeletal survey and retinal examination), potential cases of missed abusive head trauma (patients lacking either evaluation), and estimates of missed abusive head trauma (among potential cases). Group comparisons were performed using generalized linear mixed-effects models.
Intervention physicians evaluated a greater proportion of higher risk patients thoroughly (81% vs 73%, P = .11) and had fewer potential cases of missed abusive head trauma (21% vs 32%, P = .05), although estimated cases of missed abusive head trauma did not differ (7% vs 13%, P = .22). From baseline (in previous studies) to trial, the change in higher risk patients evaluated thoroughly (67%→81% vs 78%→73%, P = .01), and potential cases of missed abusive head trauma (40%→21% vs 29%→32%, P = .003), diverged significantly. We did not identify a significant divergence in the number of estimated cases of missed abusive head trauma (15%→7% vs 11%→13%, P = .22).
PediBIRN-4 CDR application facilitated changes in abuse evaluations that reduced potential cases of missed abusive head trauma in PICU settings.
ClinicalTrials.gov: NCT03162354.</abstract><cop>NEW YORK</cop><pub>Elsevier Inc</pub><pmid>33798512</pmid><doi>10.1016/j.jpeds.2021.03.055</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-8008-6232</orcidid><orcidid>https://orcid.org/0000-0002-9977-7041</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Child child abuse Child Abuse - diagnosis clinical decision rule Craniocerebral Trauma - diagnosis Critical Care Humans Intensive Care Units, Pediatric Life Sciences & Biomedicine Mass Screening Pediatrics Science & Technology screening test |
| title | A Cluster Randomized Trial to Reduce Missed Abusive Head Trauma in Pediatric Intensive Care Settings |
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