A new study published in the journal Pediatrics details the development of a new test that could help doctors identify children who may be at risk of death from physical abuse.
Study leader Prof. Alison Kemp, of the School of Medicine at Cardiff University in the UK, and colleagues say the test – called PredAHT – could help doctors recognize children who are at risk of abusive head trauma (AHT), or shaken baby syndrome (SBS) – a leading cause of child abuse deaths in the US.
AHT is the violent shaking of an infant by the shoulders, arms or legs, resulting in severe head injury.
According to the Centers for Disease Control and Prevention (CDC), almost all babies experience serious health consequences from this type of maltreatment – such as bleeding in the brain or eyes – and almost 1 in 4 babies who are violently shaken die from it.
Prof. Kemp and colleagues note, however, that it is impossible to reach a true estimation of how many infants are affected by AHT, as many cases are often missed by doctors treating infants for head injuries.
“Children with AHT present with many different combinations of clinical features, and there is ongoing controversy and debate about which clinical features support this diagnosis and clinicians’ ability to arrive at an evidence-based diagnosis,” they explain.
As such, the team has created a tool that could help doctors determine the likelihood of an infant under the age of 2 with head injuries being a victim of AHT.
The PredAHT test consists of a checklist of six clinical features of AHT: fractured ribs, long bone fractures, suspended breathing, seizures, retinal bleeding and head or neck bruising.
If doctors find an infant has three or more of these features and no accidental cause has been recognized, the infant is considered to be at high risk for AHT. Further investigations are then carried out by a team of doctors, and child protection professionals are required to assess the evidence and either confirm or reject the presence of AHT.
To validate their tool, Prof. Kemp and colleagues applied it to 168 children aged 2 years or under who had been admitted to the hospital with head injuries. Of these, 133 had been confirmed as AHT cases, while 65 had been confirmed as non-AHT cases.
The researchers say PredAHT performed well in identifying AHT cases, resulting in 72.3% sensitivity and 85.7% specificity, with the area under the curve (AUC) standing at 0.88. An AUC score of 1 represents perfect accuracy.
Based on these findings, the researchers say the tool could be used in combination with all other information on a child’s injuries and their family in order to reach an accurate AHT diagnosis.
“It is vitally important that abusive head trauma is diagnosed accurately so that the team looking after the child can ensure that they receive appropriate support and are protected from further harm,” says Prof. Kemp, noting it is “equally important” that accidental head injuries are not incorrectly diagnosed as abusive, as this could have “devastating” outcomes for the child and their family.
“However, arriving at these decisions can be extremely difficult – especially for doctors who do not see many cases of severe child abuse.
“This study offers an evidence-based clinical prediction tool to help doctors make these extremely important decisions, where the life or death of a child often hangs in the balance. Essentially, we are combining the scientific evidence at the doctor’s fingertips.”
As well as helping doctors to identify cases of AHT, the researchers say PredAHT could be of significant value to social workers, police, legal practitioners and other professionals involved in child protection.
While validation of PredAHT continues, Prof. Kemp and colleagues hope it will one day be used in clinical practice.
In June last year, Medical News Today reported on a study that found adults with a history of child abuse had lower levels of gray matter in their brain in adulthood, which may interfere with information processing.