When validating the PediBIRN-7 tool Hymel et al used criteria to classify clinical cases as abusive or not. The authors are from multiple institutions in the United States participating in the Pediatric Brain Injury Research Network (PediBIRN).
Patient selection: acutely head injured child < 3 years of age hospitalized for intensive care
Findings indicative of abusive head trauma - any of the following:
(1) The primary caregiver admits to abusive acts.
(2) Abusive acts by the primary caregiver were witnessed by an unbiased, independent observer.
(3) The primary caregiver specifically denies any head trauma AND a pre-ambulatory child in his/her care become acutely, clearly and persistently ill with clinical signs linked to traumatic cranial injuries visible on head CT or MRI.
(4) The primary caregiver's account of the child's head injury event was clearly historically inconsistent with repetition over time.
(5) The primary caregiver's account of the child's head injury event was clearly developmentally inconsistent with the child's known/expected gross motor skills.
(6) Abuse evaluations revealed patterned bruising or dry contact burns, hot water immersion burns, or CT-confirmed intra-abdominal injury.
Findings indicative of on-abusive head trauma - one or both of the following
(1) The child's head injury event was witnessed by an unbiased, independent observer who described the event as accidental (negative to abuse item 2)
(2) All of the following:
(2a) The primary caregiver provided an account of the child's head injury event that was historically consistent with repetition over time (negative to abuse item 4)
(2b) The primary caregiver provided an account developmentally consistent with the child's known or expected gross motor skills (negative to abuse item 5)
(2c) Abuse evaluation above was negative (negative for abuse item 6)
If the child does not meet the criteria for abusive or non-abusive head trauma, then it is labeled as indeterminate.
