{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:16:23Z","timestamp":1790010983523,"version":"4.0.1"},"reference-count":23,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>CONTEXT AND OBJECTIVE:<\/jats:title>\n                    <jats:p>To determine which combinations of clinical features assist in distinguishing abusive head trauma (AHT) from nonabusive head trauma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Individual patient data from 6 comparative studies of children younger than 3 years with intracranial injury were analyzed to determine the association between AHT and combinations of apnea; retinal hemorrhage; rib, skull, and long-bone fractures; seizures; and head and\/or neck bruising. An aggregate analysis of data from these studies used multiple imputation of combined clinical features using a bespoke hotdeck imputation strategy, which accounted for uncertainty arising from missing information.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Analyzing 1053 children (348 had AHT), excluding nonsignificant variables (gender, age, skull fractures), for a child with an intracranial injury and 1 or 2 of the 6 features, the positive predictive value (PPV) of AHT varies from 4% to 97% according to the different combinations. Although rarely recorded, apnea is significantly associated with AHT (odds ratio [OR]: 6.89 [confidence interval: 2.08\u201322.86]). When rib fracture or retinal hemorrhage was present with any 1 of the other features, the OR for AHT is &amp;gt;100 (PPV &amp;gt; 85%). Any combination of 3 or more of the 6 significant features yielded an OR of &amp;gt;100 (PPV for AHT &amp;gt; 85%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Probabilities of AHT can be estimated on the basis of different combinations of clinical features. The model could be further developed in a prospective large-scale study, with an expanded clinical data set, to contribute to a more refined tool to inform clinical decisions about the likelihood of AHT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2010-2949","type":"journal-article","created":{"date-parts":[[2011,8,15]],"date-time":"2011-08-15T20:19:30Z","timestamp":1313439570000},"page":"e550-e564","source":"Crossref","is-referenced-by-count":173,"title":["Estimating the Probability of Abusive Head Trauma: A Pooled Analysis"],"prefix":"10.1542","volume":"128","author":[{"given":"Sabine Ann","family":"Maguire","sequence":"first","affiliation":[{"name":"Departments of Child Health and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison Mary","family":"Kemp","sequence":"additional","affiliation":[{"name":"Departments of Child Health and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca Caroline","family":"Lumb","sequence":"additional","affiliation":[{"name":"Departments of Child Health and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Mark","family":"Farewell","sequence":"additional","affiliation":[{"name":"Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2011,9,1]]},"reference":[{"issue":"3","key":"2021120823451892100_B1","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1542\/peds.2003-1020-L","article-title":"A population-based comparison of clinical and outcome characteristics of young children with serious inflicted and noninflicted traumatic brain injury","volume":"114","author":"Keenan","year":"2004","journal-title":"Pediatrics"},{"issue":"12","key":"2021120823451892100_B2","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1097\/PEC.0b013e31818e9f5d","article-title":"Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse","volume":"24","author":"Oral","year":"2008","journal-title":"Pediatr Emerg Care"},{"issue":"1","key":"2021120823451892100_B3","first-page":"1","article-title":"The Next Innocence Project: shaken baby syndrome and the criminal courts","volume":"87","author":"Tuerkheimer","year":"2009","journal-title":"Wash Univ Law Rev"},{"key":"2021120823451892100_B4","unstructured":"Tuerkheimer\u2008D . 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