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Noorbakhsh KA, Berger RP, Smith KJ. Identification of Abusive Head Trauma in High-Risk Infants: A Cost-Effectiveness Analysis. J Pediatr. 2020;227:176-183.e3doi: 10.1016/j.jpeds.2020.06.003.
Noorbakhsh, K. A., Berger, R. P., & Smith, K. J. (2020). Identification of Abusive Head Trauma in High-Risk Infants: A Cost-Effectiveness Analysis. The Journal of pediatrics, 227176-183.e3. https://doi.org/10.1016/j.jpeds.2020.06.003
Noorbakhsh, Kathleen A, et al. "Identification of Abusive Head Trauma in High-Risk Infants: A Cost-Effectiveness Analysis." The Journal of pediatrics vol. 227 (2020): 176-183.e3. doi: https://doi.org/10.1016/j.jpeds.2020.06.003
Noorbakhsh KA, Berger RP, Smith KJ. Identification of Abusive Head Trauma in High-Risk Infants: A Cost-Effectiveness Analysis. J Pediatr. 2020 Dec;227:176-183.e3. doi: 10.1016/j.jpeds.2020.06.003. Epub 2020 Jun 10. PMID: 32531314.
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J Pediatr. 2020 Dec;227:176-183.e3. doi: 10.1016/j.jpeds.2020.06.003. Epub 2020 Jun 10.

Identification of Abusive Head Trauma in High-Risk Infants: A Cost-Effectiveness Analysis.

The Journal of pediatrics

Kathleen A Noorbakhsh, Rachel P Berger, Kenneth J Smith

Affiliations

  1. Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: [email protected].
  2. Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA.
  3. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.

PMID: 32531314 DOI: 10.1016/j.jpeds.2020.06.003

Abstract

OBJECTIVES: To evaluate the cost-effectiveness of abusive head trauma detection strategies in emergency department settings with and without rapid magnetic resonance imaging (rMRI) availability.

STUDY DESIGN: A Markov decision model estimated outcomes in well-appearing infants with high-risk chief complaints. In an emergency department without rMRI, we considered 3 strategies: clinical judgment, universal head computed tomography (CT) scan, or the Pittsburgh Infant Brain Injury Score (PIBIS) with a CT scan. In an emergency department with rMRI for brain availability, we considered additional strategies: universal rMRI, universal rMRI with a CT scan, PIBIS with rMRI, and PIBIS with rMRI followed by a CT scan. Correct diagnosis eliminated future risk; missed abusive head trauma led to reinjury risk with associated poor outcomes. Cohorts were followed for 1 year from a healthcare perspective. One-way and probabilistic sensitivity analyses were performed. The main outcomes evaluated in this study were abusive head trauma correctly identified and incremental cost per quality-adjusted life-year.

RESULTS: Without rMRI availability, PIBIS followed by a CT scan was the most cost-effective strategy. Results were sensitive to variation of CT scan-induced cancer parameters and abusive head trauma prevalence. When rMRI was available, universal rMRI followed by a confirmatory CT scan cost $25 791 to gain 1 additional quality-adjusted life-year compared with PIBIS followed by rMRI with a confirmatory CT scan. In both models, clinical judgement was less effective than alternative strategies.

CONCLUSIONS: By applying CT scans to a more targeted population, PIBIS decreases radiation exposure and is more effective for the identification of abusive head trauma compared with clinical judgment. When rMRI is available, universal rMRI with a CT scan is more effective than PIBIS and is economically favorable.

Copyright © 2020 Elsevier Inc. All rights reserved.

Keywords: child abuse; diagnostic imaging; economic analysis; traumatic brain injury

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