Hymel et al reported a clinical prediction rule (CPR) for screening a pediatric patient for abusive head trauma. The authors are from the Pediatric Brain Injury Research Network (PediBIRN) in the United States and Canada.

Patient selection: age < 3 years, with acute head injury admitted for intensive care

Exclusions: motor vehicle accident, pre-existing brain malformation, infection, hypoxia-ischemia


Screening exam - one or more of the following

(1) any clinically significant respiratory compromise before admission (labored breathing, irregular breathing, apnea, need for intubation, need for assisted ventilation)

(2) any bruising to ears, neck or torso (chest, back, abdomen, buttocks, genitourinary region)

(3) any subdural hemorrhages or fluid collections that are bilateral or that involve the interhemispheric space

(4) any skull fracture other than an isolated, unilateral, nondiastatic, linear, parietal skull fracture


A child with one or more positive findings on the screening exam should be screened for physical abuse.



• The screening exam is sensitive (96%) with a specificity ranging from 36 to 46%.

• The predictive value will be affected by the prevalence of abuse in the community.

• The area under the ROC curve was 0.78.

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