Penn State Health Children’s Hospital, College of Medicine researchers develop tool to reduce missed pediatric abusive head traumas
Results of a randomized controlled trial led by Penn State College of Medicine researchers showed that a child abuse screening tool they developed may prevent doctors from missing cases of abusive head trauma in pediatric patients. The research team said that applying the tool accurately and consistently in pediatric intensive care units (PICUs) could save lives, reduce hospital costs and lessen the negative effects of physicians’ inexperience, implicit bias and practice disparities.
The screening tool comes in the form of a clinical decision rule. It directs physicians to launch abuse evaluations on every young patient with an acute head injury who comes to the hospital with one or more of four medical findings. Applied accurately and consistently at the time of hospital admission, it will identify 96% of cases. Dr. Kent Hymel, professor of pediatrics, founded and directs the research network that developed the clinical decision rule. He said that establishing best practices for evaluating and diagnosing child maltreatment is crucial, though stigma and other factors can prevent proper evaluations of child abuse from occurring.
“If evidence-based screening was a routine clinical practice, fewer abuse cases would be missed, parents might feel less directly stigmatized and health care costs linked to ‘missing’ a critical diagnosis would likely decrease,” Hymel said.
To test the tool’s effectiveness, PICU and child abuse physicians at four U.S. academic medical centers were trained and encouraged to apply the clinical decision rule as a screening tool for abusive head trauma for a period of 32 months. Their child abuse evaluations and relevant patient outcomes were compared to four control PICUs where the tool was not applied.
“Our study showed that applying the clinical decision rule at or near the time of PICU admission significantly increased evaluations of higher-risk patients and reduced potential cases of missed abusive head trauma, compared to control sites,” Hymel said.
The research team plans to further evaluate the clinical decision rule in future trials in less well-controlled and more diverse clinical settings.
Veronica Armijo-Garcia, Natalie Kissoon, Maria Woosley and Dorinda Escamilla-Padilla of University of Texas Health Science Center; Matthew Musick, Reena Isaac and Nancy Jaimon of Baylor College of Medicine; Mark Marinello and Robin Foster of Children’s Hospital of Richmond; Bruce Herman and Kristine Campbell of University of Utah School of Medicine; Kerri Weeks of University of Kansas School of Medicine; Suzanne Haney and Lucinda Kustka of University of Nebraska Medical Center; Terra Frazier and Kelly Tieves of Children’s Mercy Hospital; Christopher Carroll and Nina Livingston of Connecticut Children’s Medical Center; Jennie Noll of Penn State and Ashley Bucher, Ming Wang, Vernon Chinchilli and Mark Dias of Penn State College of Medicine also contributed to this research.
This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and Penn State Clinical and Translational Science Institute through the National Center for Advancing Translational Sciences (Grant number UL1TR002014). The authors declare no conflicts of interest.
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