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Prediction of Intent

Robert G. Wells, MD; Christine Vetter, MD; Prakash Laud, PhD

Arch Pediatr Adolesc Med. 2002;156:252-257.

Objective  To determine whether certain computed tomographic imaging patterns in infants and young children with intracranial hemorrhage help predict intentional compared with unintentional injuries.

Design  Retrospective consecutive case series over a 10-year period.

Patients  Two hundred ninety-three children younger than 3 years with intracranial hemorrhage.

Main Outcome Measures  The sensitivity and specificity of computed tomographic imaging patterns for intentional head injury.

Setting  Regional pediatric medical center.

Results  Four variables used in the multiple logistic regression analysis for predicting intentional head injury were statistically significant (P<.05): subdural hematoma located over the cerebral convexities, hematoma within the interhemispheric subdural space, hygroma (nonhemic subdural fluid) with intracranial hemorrhage, and absence of a skull fracture with intracranial hemorrhage. The prediction model for the diagnosis of intentional head trauma using combinations of these 4 variables and a .45 probability cutoff point indicated a sensitivity of 84% (95% confidence interval, 78%-90%) and a specificity of 83% (95% confidence interval, 74%-89%).

Conclusion  Computed tomographic imaging patterns of intracranial hemorrhage in children younger than 3 years help predict whether the injury was intentional.

From the Radiology Department, Children's Hospital of Wisconsin, Milwaukee (Dr Wells); and the Division of Biostatistics, Medical College of Wisconsin, Milwaukee (Dr Laud). Dr Vetter is in private practice in Singapore.

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