Frequently Asked Questions

To inform—not dictate—clinical decisions to either launch or forego an abuse evaluation.

As a screening tool—not as a diagnostic tool. Some acutely head-injured children with low estimates of abuse probability might still need a workup for abuse. Conversely, some acutely head-injured children with high estimates of abuse probability might not have been abused.

At or near the time of admission to the PICU, when initial history, physical examination, and head imaging studies are complete.

For children under 3 years of age hospitalized for intensive care of acute, closed, traumatic, head injuries confirmed by initial CT or MR imaging. The screening tool should not be applied to patients with pre-existing brain malformation, disease, infection, or hypoxia-ischemia; or to patients with head injuries resulting from collisions involving a motor vehicle.

Clinicians answer four questions, and the screening tool returns an evidence-based, patient-specific, estimate of the probability of abuse.

We can also provide information about the diagnostic yield of abuse evaluations observed in equivalent patients who were evaluated for abuse.

The screening tool was derived in a prospective study of 209 acutely head-injured children <3 years of age admitted to one of 14 PICUs. To create the tool, investigators: (1) applied a priori definitional criteria to sort patients into comparison groups of abusive vs. non-abusive head trauma; (2) identified 13 reliable clinical variables readily available at or near the time of PICU admission; (3) applied a recursive partitioning algorithm designed to penalize missed cases of AHT; and (4) identified a 4-variable cluster of these 13 variables that—alone or in combination—detected AHT with sensitivity ≥0.96.

Yes, in a subsequent study of 291 acutely head-injured patients <3 years of age admitted to one of 14 PICUs.