The decision to pursue a workup for abusive head trauma (AHT) in infants and young children can be difficult. This study reports a prospective, multicenter, observational, cross-sectional study to validate a 4-variable abusive head trauma clinical prediction rule (AHT CPR) upon PICU admission. When any one of the variables (clinically significant respiratory compromise before admission; any bruising of ears, neck, or torso; any bilateral or interhemispheric subdural fluid collections; skull fracture other than linear parietal fracture) is present, sensitivity for meeting clinical diagnostic criteria for AHT is 96%. Specificity is 46%. This validation study included 291 patients from 14 PICUs. Patient characteristics and results were similar to the earlier derivation study, and secondary analyses showed similar performance in different regions of the country and in different size PICUs. The AHT CPR performs well as a screening tool, considering factors that are easily assessed at the time of PICU admission, with a high sensitivity for patients ultimately diagnosed with AHT.
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