Berger et al reported the Pittsburgh Infant Brain Injury Score (PIBIS) which can help to identify an infant with abusive head trauma (AHT). The authors are from Children's Hospital of Pittsburgh, University of Utah, Ann & Robert H. Lurie Children's Hospital in Chicago, Hofstra North Shore Long Island School of Medicine and Statistical Analysis and Measurement Consultants in Lanexa, Virginia.
Patient selection: infant from 30 to 364 days old (1 to 12 months), afebrile, well-appearing, being evaluated for a finding that may be associated with abusive head trauma
Parameters:
(1) abnormality on dermatologic exam (bruising, skin swelling, abrasions, lacerations, scratches, subconjunctival hemorrhage, etc).
(2) age in months
(3) head circumference as percentile for age, gender and race
(4) blood hemoglobin in g/dL
|
Parameter
|
Finding
|
Points
|
|
skin exam
|
normal
|
0
|
|
|
abnormal
|
2
|
|
age in months
|
< 3 months
|
0
|
|
|
>= 3 months
|
1
|
|
head circumference
|
<= 85th percentile
|
0
|
|
|
> 85th percentile
|
1
|
|
hemoglobin
|
>= 11.2 g/dL
|
0
|
|
|
< 11.2 g/dL
|
1
|
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• A score >= 2 had a sensitivity of 93% and specificity of 53%.
• A score >= 3 had a sensitivity of 81% and specificity of 75%.
Performance:
• The area under the ROC curve is reported as 0.83.
