Abstract
Doctors who treat young victims of trauma are required to make important decisions to launch or forgo child abuse evaluations in their acutely head-injured patients. To improve the accuracy of these decisions, Pediatric Brain Injury Research Network (PediBIRN) investigators derived and validated a 4-variable clinical prediction rule (CPR) that improves the detection of abusive head trauma (AHT) in pediatric intensive care units. Our objective was to estimate and compare medical costs from the health system perspective of AHT screening guided by the CPR vs. screening as usual (SAU). Cost estimates for child abuse evaluations, emergency department (ED)/pediatrician visits, and hospital admissions for AHT were combined with published data on service use and re-injury rates in children with missed or unrecognized AHT. Applying published estimates of the CPR’s potential screening performance, the cost per correctly identified child with AHT was calculated and compared for AHT screening guided by the CPR vs. SAU, and the potential medical cost savings associated with CPR application was estimated. Applied accurately and consistently, the CPR could reduce the cost per correctly identified child with AHT by 15.1%, and reduce health system costs resulting from missed AHT by 72.4%.
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Barlow, K. M., & Minns, R. A. (2000). Annual incidence of shaken impact syndrome in young children. Lancet, 356, 1571–1572.
Gill, J. R., Goldfeder, L. B., Armbrustmacher, V., Coleman, A., Mena, H., & Hirsch, C. S. (2009). Fatal head injury in children younger than 2 years in New York city and an overview of the shaken baby syndrome. Archives of Pathology & Laboratory Medicine, 133, 619–627.
Guyatt, G., Haynes, B., Jaeschke, R., Cook, D., Greenhalgh, T., Meade, M., & Richardson, W. (2002). Introduction: The philosophy of evidence-based medicine. In G. Guyatt & D. Rennie (Eds.), Users’ guide to the medical literature: A manual for evidence-based clinical practice. Chicago, IL: American Medical Association.
Herman-Giddens, M. E., Brown, G., Verbiest, S., Carlson, P. J., Hooten, E. G., Howell, E., & Butts, J. D. (1999). Underascertainment of child abuse mortality in the United States. Journal of the American Medical Association, 282, 463–467.
Hymel, K. P., Armijo-Garcia, V., Foster, R., Frazier, T. N., Stoiko, M., & Christie, L. M., Pediatric Brain Injury Research Network (PediBIRN) Investigators. (2014). Validation of a clinical prediction rule for pediatric abusive head trauma. Pediatrics 134, E1537–E1544.
Hymel, K. P., Herman, B. E., Narang, S. K., Graf, J. M., Frazier, T. N., & Stoiko, M., Pediatric Brain Injury Research Network (PediBIRN) Investigators. (2015). Potential impact of a validated screening tool for a pediatric abusive head trauma. Journal of Pediatrics, 167, 1375–1381.e1371.
Hymel, K. P., Willson, D. F., Boos, S. C., Pullin, D. A., Homa, K., & Lorenz, D. J., Pediatric Brain Injury Research Network (PediBIRN) Investigators. (2013). Derivation of a clinical prediction rule for pediatric abusive head trauma. Pediatric Critical Care Medicine, 14, 210–220.
Jenny, C., Hymel, K. P., Ritzen, A., Reinert, S. E., & Hay, T. C. (1999). Analysis of missed cases of abusive head trauma. Journal of the American Medical Association, 281, 621–626.
Jones, R., Flaherty, E. G., Binns, H. J., Price, L. L., Slora, E., Abney, D., & Sege, R. D. (2008). Clinicians’ description of factors influencing their reporting of suspected child abuse: Report of the child abuse reporting experience study research group. Pediatrics, 122, 259–266.
Keenan, H. T., Runyan, D. K., Marshall, S. W., Nocera, M. A., Merten, D. F., & Sinal, S. H. (2003). A population-based study of inflicted traumatic brain injury in young children. Journal of the American Medical Association, 290, 621–626.
Lane, W. G., & Dubowitz, H. (2007). What factors affect the identification and reporting of child abuse-related fractures? Clinical Orthopaedics and Related Research, 461, 219–225.
Lane, W. G., Rubin, D. M., Monteith, R., & Christian, C. W. (2002). Racial differences in the evaluation of pediatric fractures for physical abuse. Journal of the American Medical Association, 288, 1603–1609. https://doi.org/10.1001/jama.288.13.1603.
Levi, B. H., & Brown, G. (2005). Reasonable suspicion: A study of Pennsylvania pediatricians regarding child abuse. Pediatrics, 116, E5–E12.
Levi, B. H., Brown, G., & Erb, C. (2006). Reasonable suspicion: A pilot study of pediatric residents. Child Abuse and Neglect, 30, 345–356.
Lindberg, D. M., Lindsell, C. J., & Shapiro, R. A. (2008). Variability in expert assessments of child physical abuse likelihood. Pediatrics, 121, E945–E953.
McGinn, T., Guyatt, G., Wyer, P., Naylor, C., & Stiell, I. (2002). Diagnosis: clinical prediction rules. In G. Guyatt & D. Rennie (Eds.), Users’ guides to the medical literature: A manual for evidence-based clinical practice (pp. 473–482). Chicago, IL: American Medical Association.
Minns, R. A., & Brown, J. K. (2005). Shaking and other non-accidental head injuries in children. London: Mac Keith Cambridge University Press.
Offer-Shechter, S., Tirosh, E., & Cohen, A. (2000). Physical abuse - physicians knowledge and reporting attitude in Israel. European Journal of Epidemiology, 16, 53–58.
Peterson, C., Xu, L., Florence, C., & Parks, S. E. (2015). Annual cost of U.S. hospital visits for pediatric abusive head trauma. Child Maltreatment, 20, 162–169.
Rangel, E. L., Cook, B. S., Bennett, B. L., Shebesta, K., Ying, J., & Falcone, R. A. (2009). Eliminating disparity in evaluation for abuse in infants with head injury: Use of a screening guideline. Journal of Pediatric Surgery, 44, 1229–1235.
Reece, R. M., & Sege, R. (2000). Childhood head injuries - Accidental or inflicted? Archives of Pediatrics & Adolescent Medicine, 154, 11–15.
Schnitzer, P. G., Covington, T. M., Wirtz, S. J., Verhoek-Oftedahl, W., & Palusci, V. J. (2008). Public health surveillance of fatal child maltreatment: Analysis of 3 state programs. American Journal of Public Health, 98, 296–303.
Trokel, M., Wadimmba, A., Griffith, J., & Sege, R. (2006). Variation in the diagnosis of child abuse in severely injured infants. Pediatrics, 117, 722–728.
U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children Youth and Families, & Children’s Bureau. Child Maltreatment 2012 (2015) http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment. Accessed 23 Sept 2015
Wood, J. N., Hall, M., Schilling, S., Keren, R., Mitra, N., & Rubin, D. M. (2010). Disparities in the evaluation and diagnosis of abuse among infants with traumatic brain injury. Pediatrics, 126, 408–414.
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Cohrs, A.C., Agbese, E., Leslie, D.L. et al. A Cost Analysis of a Validated Screening Tool for Pediatric Abusive Head Trauma. J Child Fam Stud 27, 750–755 (2018). https://doi.org/10.1007/s10826-017-0925-z
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DOI: https://doi.org/10.1007/s10826-017-0925-z