Potential impact of the validated Predicting Abusive Head Trauma (PredAHT) clinical prediction tool: A clinical vignette study |
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| Institution: | 1. Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106, USA;1. Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH;2. Department of Pediatrics, University of Utah School of Medicine, Primary Children''s Medical Center, Salt Lake City, UT;3. Department of Pediatrics, University of Texas Health Science Center, Houston, TX;4. Department of Pediatrics, Baylor College of Medicine, Texas Children''s Hospital, Houston, TX;5. Department of Pediatrics, Children''s Mercy Hospital, Kansas City, MO;6. Department of Pediatrics, DeVos Children''s Hospital, Grand Rapids, MI;7. Department of Critical Care, Dell Children''s Medical Center of Central Texas, Austin, TX;8. Children''s Physician Services of South Texas, Driscoll Children''s Hospital, Corpus Christi, TX;9. Department of Pediatrics, Connecticut Children''s Medical Center, Hartford, CT;10. Department of Pediatrics, Baystate Children''s Hospital, Springfield, MA;11. Departments of Neurosurgery and Pediatrics, Penn State College of Medicine, Hershey, PA;12. Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH;13. Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA;1. Children''s Hospital and Medical Center, Omaha, Nebraska;2. University of Nebraska Medical Center, Omaha, Nebraska;1. School of Medicine, Cardiff University, United Kingdom;2. School of Social and Community Medicine, University of Bristol, United Kingdom;3. University of the West of England, Bristol, United Kingdom;1. Burn Centre Rotterdam, Maasstad Hospital, Rotterdam, The Netherlands;2. Division of Pediatrics, Maasstad Hospital, Rotterdam, The Netherlands;3. Child Abuse Team (Veilig thuis Zuid-Holland Zuid), Dordrecht, the Netherlands;4. Association of Dutch Burn Centres, Burn Centre Rotterdam, Maasstad Hospital, Rotterdam, The Netherlands |
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| Abstract: | BackgroundThe validated Predicting Abusive Head Trauma (PredAHT) tool estimates the probability of abusive head trauma (AHT) in children <3 years old with intracranial injury.ObjectiveTo explore the impact of PredAHT on clinicians’ AHT probability estimates and child protection (CP) actions, and assess inter-rater agreement between their estimates and between their CP actions, before and after PredAHT.Participants and SettingTwenty-nine clinicians from different specialties, at teaching and community hospitals.MethodsClinicians estimated the probability of AHT and indicated their CP actions in six clinical vignettes. One vignette described a child with AHT, another described a child with non-AHT, and four represented “gray” cases, where the diagnosis was uncertain. Clinicians calculated the PredAHT score, and reported whether this altered their estimate/actions. The ‘think-aloud’ method was used to capture the reasoning behind their responses. Analysis included linear modelling, linear mixed-effects modelling, chi-square tests, Fisher’s exact tests, intraclass correlation, Gwet’s AC1 coefficient and thematic analysis.ResultsOverall, PredAHT significantly influenced clinicians’ probability estimates in all vignettes (p < 0.001), although the impact on individual clinicians varied. However, the influence of PredAHT on clinicians’ CP actions was limited; after using PredAHT, 9/29 clinicians changed their CP actions in only 11/174 instances. Clinicians’ AHT probability estimates and CP actions varied somewhat both before and after PredAHT. Qualitative data suggested that PredAHT may increase clinicians’ confidence in their decisions when considered alongside other associated clinical, historical and social factors.ConclusionsPredAHT significantly influenced clinicians’ AHT probability estimates, but had minimal impact on their CP actions. |
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| Keywords: | Abusive head trauma Child physical abuse Clinical prediction tool Child protection |
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