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Physicians: .25 AMA PRA Category I CreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours

Release Date: December 10, 2014
Expiration Date: December 10, 2015

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon above.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:

1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD
Assistant Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Executive Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP
Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company


Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 9, has been reviewed and is acceptable for up to 15.25 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 5, 2014. Term of approval is for one year from this date. Each EBM Focus is approved for .25 Prescribed credits. Credit may be claimed for one year from the date of each update. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour(s) of continuing education by the American Association of Nurse Practitioners. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.

Program ID: 1405237E2

Last week 561 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 223 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article was selected by the DynaMed Editorial Team.

The AHT Clinical Prediction Rule Helps to Rule Out Abusive Head Trauma in Children < 3 Years Old Admitted to the Pediatric Intensive Care Unit with Acute Head Injury
Reference: Pediatrics 2014 Dec;134(6):e1537 (level 1 [likely reliable] evidence)

When a young child presents to the hospital with acute head trauma, physicians must carefully consider the possibility of abuse. Misdiagnosing abuse can have tragic consequences, as children returned to abusive situations may suffer additional abuse or even death. Unfortunately, several studies have found physician judgment of when to screen for child abuse to be significantly biased, especially in children presenting with acute head injury (Pediatrics 2006 Mar;117(3):722, Clin Orthop Relat Res 2007 Aug;461:219, Pediatrics 2010 Sep;126(3):408). To help physicians decide when to investigate for abuse, the Pediatric Brain Injury Research Network developed an abusive head trauma (AHT) clinical prediction rule (Pediatr Crit Care Med 2013 Feb;14(2):210), which was recently validated in 291 children < 3 years old admitted to 1 of 14 pediatric intensive care units (PICUs) with acute head injury.

The study excluded all children injured in a car accident as well as those with radiologic evidence of preexisting brain malformation, disease, infection, or hypoxia-ischemia. Abusive head trauma was diagnosed by predefined criteria in 43% of children. The AHT clinical prediction rule consists of 4 variables that can be assessed at or near the time of PICU admission including: i) clinically significant respiratory compromise at scene of injury, during transport, in the emergency department, or before admission; ii) bruising involving the child’s ears, neck, or torso; iii) bilateral or interhemispheric subdural hemorrhage or fluid collection; iv)and skull fracture other than isolated, unilateral, nondiastatic, linear, parietal fracture. The presence of 1 or more factors had high sensitivity, but low specificity for predicting abusive head trauma, with a positive predictive value of 55% (95% CI 48%-62%) and a negative predictive value of 93% (95% CI 85%-98%).

The performance of the AHT clinical prediction rule in this validation cohort matched or exceeded its performance in the original derivation study (Pediatr Crit Care Med 2013 Feb;14(2):210) and suggests this prediction rule may help rule out abuse in children presenting with acute head injury. The negative predictive value was not 100%, however, and a small number of children ultimately diagnosed with abusive head trauma were categorized as low risk. Furthermore, both the original derivation study and this validation study were conducted in children admitted to the PICU and the performance of this rule is as of yet untested in non-PICU populations. The AHT clinical prediction rule may help increase physician confidence when ruling out abuse, but a low risk score should not deter further investigation if abuse is suspected.

For more information, see the Moderate to severe traumatic brain injury and Concussion and mild traumatic brain injury topics in DynaMed.

DynaMed Careers

The DynaMed editorial team is seeking specialist editors in the following fields: ENT, Gastroenterology, Hematology, Oncology (especially Breast cancer, Head and neck cancer, Pancreatic cancer), Ophthalmology, Orthopedics, Pediatric Neurology, and Vascular.

If interested, please send a recent copy of your CV to Rachel Brady at rbrady@ebsco.com.

PEMSoft Mobile

Free Trial of PEMSoft Mobile Available For iPhone, iPad, and Android Devices

The PEMSoft Mobile app, a pediatric evidence-based point-of-care medical reference tool for hospitals, emergency departments, clinics, pediatric group practices, transport services, and medical schools, is now available from EBSCO Health. Designed by pediatricians, emergency physicians and other medical specialists, the vast content in PEMSoft addresses the entire spectrum of neonatal, infant, child, adolescent and young adult health. PEMSoft authors adhere to a strict evidence-based editorial policy focused on systematic identification, evaluation and consolidation of practice-changing clinical literature.

Content in the PEMSoft Mobile app covers more than 3,000 conditions and includes a similar number of medical illustrations, clinical images and videos. PEMSoft Mobile also includes explicit step-by-step emergency critical care procedures, information about common pediatric signs and symptoms, and topics covering pediatric injuries and management approaches.

Visit the PEMSoft Mobile App Trial page to access a free trial for both Apple and Android devices.

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