ArticlePediatrics2022
Traumatic Head Injury and the Diagnosis of Abuse: A Cluster Analysis.
Article in Pediatrics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- Unsupervised Clustering in Neurocritical Care: A Systematic Review.Neurocritical care · 2025Pooled it
- Medical findings in young patients with head trauma: How strong is the evidence for abuse?International journal of legal medicine · 2026Article
- Infliximab as an Effective Second-Line Treatment for IVIG-Resistant Kawasaki Disease Accompanied by Severe Dyslipidemia.Pediatric cardiology · 2026Article
- Reconsidering Pathophysiological pathways in abusive infant shaking: Questions beyond the triad.Forensic science international. Synergy · 2026Article
- Pathophysiological hypotheses of the triad in abusive infant shaking: A systematic review and analysis of corroborated cases.Forensic science international. Synergy · 2025Article
- A critical review of the American Academy of Pediatrics technical report on abusive head trauma.Forensic science international. Synergy · 2025Review
- Heterogeneity in Kawasaki disease patients with coronary artery abnormalities investigated by data-driven cluster analysis.Pediatric research · 2025Article
- Policy critique: The conflation of shaken baby syndrome and abusive head trauma - a measure with several negative effects.Forensic science international. Synergy · 2025Article
- Not all quad bikers are the same: unsupervised cluster analysis identifying injury risk groups among quad bike riders in Dubai, UAE.BMJ public health · 2025Article
- Evidence for significant misdiagnosis of abusive head trauma in pediBIRN data.Forensic science international. Synergy · 2023Article
- Why admitted cases of AHT make a low quality reference standard: A survey of people accused of AHT in France.Forensic science international. Synergy · 2023Article
- Abusive head injuries in infants corroborated versus non-corroborated cases: more answers to more questions.Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2022Article
- An analysis of physicians' diagnostic reasoning regarding pediatric abusive head trauma.Child abuse & neglect · 2022Article
- Parenchymal Insults in Abuse-A Potential Key to Diagnosis.Diagnostics (Basel, Switzerland) · 2022Review
- Article
Corrections and comments
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Authors and funding
4 authors at 4 institutions in 2 countries.
Funding
Abstract
objectivesData guiding abusive head trauma (AHT) diagnosis rest on case-control studies that have been criticized for circularity. We wished to sort children with neurologic injury using mathematical algorithms, without reference to physicians' diagnoses or predetermined diagnostic criteria, and to compare the results to existing AHT data, physicians' diagnoses, and a proposed triad of findings.
methodsUnsupervised cluster analysis of an existing data set regarding 500 young patients with acute head injury hospitalized for intensive care. Three cluster algorithms were used to sort (partition) patients into subpopulations (clusters) on the basis of 32 reliable (κ > 0.6) clinical and radiologic variables. P values and odds ratios (ORs) identified variables most predictive of partitioning.
resultsThe full cohort partitioned into 2 clusters. Variables substantially (P < .001 and OR > 10 in all 3 cluster algorithms) more prevalent in cluster 1 were imaging indications of brain hypoxemia, ischemia, and/or swelling; acute encephalopathy, particularly when lasting >24 hours; respiratory compromise; subdural hemorrhage or fluid collection; and ophthalmologist-confirmed retinoschisis. Variables substantially (P < .001 and OR < 0.10 in any cluster algorithm) more prevalent in cluster 2 were linear parietal skull fracture and epidural hematoma. Postpartitioning analysis revealed that cluster 1 had a high prevalence of physician-diagnosed abuse.
conclusionsThree cluster algorithms partitioned the population into 2 clusters without reference to predetermined diagnostic criteria or clinical opinion about the nature of AHT. Clinical difference between clusters replicated differences previously described in comparisons of AHT with non-AHT. Algorithmic partition was predictive of physician diagnosis and of the triad of findings heavily discussed in AHT literature.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.