背景:PediBIRN-7临床预测规则结合了已完成的滥用评估的(阳性或阴性)预测性贡献,以估计滥用评估后的滥用性头部创伤(AHT)概率。应用定义标准作为AHT和非AHT基本事实的代理,灵敏度为0.73(95%CI:0.66-0.79),特异性0.87(95%CI:0.82-0.90),在其推导研究中,ROC-AUC为0.88(95%CI:0.85-0.92)。
目的:为了验证PediBIRN-7的AHT预测性能,等效,患者人群。
方法:连续,头部严重受伤的儿童<3岁,在2017年至2020年期间在8个地点接受重症监护,完成骨骼调查和视网膜检查(N=342)。
方法:对现有的,横截面,前瞻性数据集,包括分配患者特定的AHT概率估计,AHT预测性能度量的计算(ROC-AUC,灵敏度,特异性,预测值),并完成敏感性分析,以估计最佳和最差情况的预测性能。
结果:应用相同的定义标准,PediBIRN-7的灵敏度为0.74(95%CI:0.66-0.81),特异性0.77(95%CI:0.70-0.83),和ROC-AUC0.83(95%CI:0.78-0.88)。ROC-AUC的降低在统计学上不显著(p=.07)。应用医生最终共识诊断作为AHT和非AHT基本事实的代理,PediBIRN-7的灵敏度为0.73(95%CI:0.66-0.79),特异性0.87(95%CI:0.82-0.90),和ROC-AUC0.90(95%CI:0.87-0.94)。敏感性分析表明,规则性能的变化很小。
结论:PediBIRN-7的总体AHT预测性能已在一个新颖的,等效,患者人群。其对AHT概率的患者特异性估计可以在滥用评估后告知医师与AHT相关的诊断推理。
BACKGROUND: The PediBIRN-7 clinical prediction rule incorporates the (positive or negative) predictive contributions of completed abuse evaluations to estimate abusive head trauma (AHT) probability after abuse evaluation. Applying definitional criteria as proxies for AHT and non-AHT ground truth, it performed with sensitivity 0.73 (95 % CI: 0.66-0.79), specificity 0.87 (95 % CI: 0.82-0.90), and ROC-AUC 0.88 (95 % CI: 0.85-0.92) in its derivation study.
OBJECTIVE: To validate the PediBIRN-7\'s AHT prediction performance in a novel, equivalent, patient population.
METHODS: Consecutive, acutely head-injured children <3 years hospitalized for intensive care across eight sites between 2017 and 2020 with completed skeletal surveys and retinal exams (N = 342).
METHODS: Secondary analysis of an existing, cross-sectional, prospective dataset, including assignment of patient-specific estimates of AHT probability, calculation of AHT prediction performance measures (ROC-AUC, sensitivity, specificity, predictive values), and completion of sensitivity analyses to estimate best- and worst-case prediction performances.
RESULTS: Applying the same definitional criteria, the PediBIRN-7 performed with sensitivity 0.74 (95 % CI: 0.66-0.81), specificity 0.77 (95 % CI: 0.70-0.83), and ROC-AUC 0.83 (95 % CI: 0.78-0.88). The reduction in ROC-AUC was statistically insignificant (p = .07). Applying physicians\' final consensus diagnoses as proxies for AHT and non-AHT ground truth, the PediBIRN-7 performed with sensitivity 0.73 (95 % CI: 0.66-0.79), specificity 0.87 (95 % CI: 0.82-0.90), and ROC-AUC 0.90 (95 % CI: 0.87-0.94). Sensitivity analyses demonstrated minimal changes in rule performance.
CONCLUSIONS: The PediBIRN-7\'s overall AHT prediction performance has been validated in a novel, equivalent, patient population. Its patient-specific estimates of AHT probability can inform physicians\' AHT-related diagnostic reasoning after abuse evaluation.