A Clinical Prediction Rule for Abusive Head Trauma

Because the history is unreliable and physical examination findings are insensitive, abusive head trauma (AHT) is notoriously difficult to diagnose, and the consequences of missing AHT can be devastating. In a prospective multicenter study, these authors validated a previously derived clinical prediction rule to identify subtle AHT. Well-appearing, afebrile (temperature <38.3°C) infants (age, 30–364 days) without a history of trauma were included if they presented with one of the following complaints: apparent life-threatening event (ALTE)/apnea, vomiting >4 episodes without diarrhea, seizures, scalp swelling, bruising, or other neurologic symptoms such as lethargy.

The 5-point clinical prediction rule, called the Pittsburgh Infant Brain Inj…