A Cluster Randomized Trial to Reduce Missed Abusive Head Trauma in Pediatric Intensive Care Settings - 23/08/21
for the
Pediatric Brain Injury Research Network (PediBIRN) Investigators
Abstract |
Objective |
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.
Study design |
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.
Results |
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).
Conclusions |
PediBIRN-4 CDR application facilitated changes in abuse evaluations that reduced potential cases of missed abusive head trauma in PICU settings.
Trial registration |
ClinicalTrials.gov: NCT03162354.
Le texte complet de cet article est disponible en PDF.Key words : child abuse, screening test, clinical decision rule
Abbreviations : CAP, CDR, CRT, PediBIRN, PI, PICU
Plan
| Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, United States (P50HD089922). Additional support was provided by The Penn State Clinical & Translational Research Institute, Pennsylvania State University Clinical and Translational Science Award (CTSA) (National Institutes of Health, United States/CTSA UL1 TR002014). The National Institutes of Health and Pennsylvania State University had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Pennsylvania State University. The authors declare no conflicts of interest. |
Vol 236
P. 260 - septembre 2021 Retour au numéro
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