ArticleThe Journal of pediatrics2021
A Cluster Randomized Trial to Reduce Missed Abusive Head Trauma in Pediatric Intensive Care Settings.
Article in The Journal of pediatrics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03162354 (Implementation Trial of a Validated Clinical Decision Rule for Pediatric Abusive Head Trauma), which is not on this map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Implementation Trial of a Validated Clinical Decision Rule for Pediatric Abusive Head Trauma (NIH Grant Number P50HD089922)
Who cites it
7 citing papers in PubMed, 18 citations in OpenAlex.
- Medical findings in young patients with head trauma: How strong is the evidence for abuse?International journal of legal medicine · 2026Article
- Validation of the PediBIRN-7 clinical prediction rule for pediatric abusive head trauma.Child abuse & neglect · 2024Article
- Data-driven evidence shows truthful caregiver histories and significant overdiagnosis of abusive head trauma.Annals of the Child Neurology Society · 2023Article
- Skeletal survey yields in low vs. high risk pediatric patients with skull fractures.Child abuse & neglect · 2023Article
- Evidence for significant misdiagnosis of abusive head trauma in pediBIRN data.Forensic science international. Synergy · 2023Article
- An analysis of physicians' diagnostic reasoning regarding pediatric abusive head trauma.Child abuse & neglect · 2022Article
- Screening for pediatric abusive head trauma: Are three variables enough?Child abuse & neglect · 2022Article
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Authors and funding
25 authors at 10 institutions in 1 country.
Funding
Abstract
objectiveTo 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
designThis 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.
resultsIntervention 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).
conclusionsPediBIRN-4 CDR application facilitated changes in abuse evaluations that reduced potential cases of missed abusive head trauma in PICU settings.
trial registrationClinicalTrials.gov: NCT03162354.
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Registered trials
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