Welcome to the CDR Implementation Trial!

Doctors’ decisions to launch or forgo child abuse evaluations in their young, hospitalized, acutely head-injured patients can be difficult, and the stakes can be high.1 To guide and inform these decisions, Pediatric Brain Injury Research Network (PediBIRN) investigators conducted sequential multicenter studies to derive and to validate an effective screening tool for abusive head trauma (AHT).2,3

This AHT screening tool comes in the form of a clinical prediction or decision rule (CDR). Applied at the time of PICU admission, the CDR recommends a thorough abuse evaluation for all “high risk” patients who present with closed head trauma and any one or more of its four predictor variables.

Applied accurately and consistently, the CDR would have correctly identified (categorized as “high risk”) 96% of patients (N=500) who met a priori criteria for AHT, 98% of patients ultimately diagnosed with AHT, and 99% of patients whose completed retinal exams and/or skeletal surveys revealed additional findings of abuse.3 Secondary, theoretical analyses suggest that application of our AHT screening tool could increase AHT detection from 87% to 96% of cases (P <.001), while decreasing overall abuse evaluations.4

Though promising, the CDR's actual impact on AHT screening accuracy has never been formally assessed.  To this end, PediBIRN investigators are conducting a “CDR Implementation Trial” at eight PICU sites to test “AHT screening guided by the CDR” compared to “AHT screening as usual.” A clear demonstration of the CDR’s positive clinical impacts in actual PICU settings will inform and accelerate subsequent efforts to disseminate the CDR more broadly.  This website was created to facilitate the successful execution of this “CDR Implementation Trial”.

Selected References:

  1. Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC. Analysis of missed cases of abusive head trauma. JAMA. Feb 17 1999;281(7):621-626.11.
  2. Hymel KP, Willson DF, Boos SC, et al. Derivation of a clinical prediction rule for pediatric abusive head trauma. Pediatr Crit Care Med. Feb 2013;14(2):210-220.
  3. Hymel KP, Armijo-Garcia V, Foster R, et al. Validation of a clinical prediction rule for pediatric abusive head trauma. Pediatrics. Dec 2014;134(6):e1537-1544.
  4. Hymel KP, Herman BE, Narang SK, et al. Potential Impact of a Validated Screening Tool for Pediatric Abusive Head Trauma. J Pediatr. Dec 2015;167(6):1375-1381 e1371.