Acceptability of the Predicting Abusive Head Trauma (PredAHT) clinical prediction tool: A qualitative study with child protection professionals

• Published in: Child abuse & neglect Vol. 81; pp. 192 - 205
• Main Authors: Cowley, Laura E., Maguire, Sabine, Farewell, Daniel M., Quinn-Scoggins, Harriet D., Flynn, Matthew O., Kemp, Alison M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2018; Elsevier Science Ltd
• Subjects: Abusive head trauma; Adult; Apnea; Attitude of Health Personnel; Attorneys; Bones; Child; Child Abuse; Child abuse & neglect; Child Abuse - diagnosis; Child physical abuse; Child protection; Child Protective Services - statistics & numerical data; Child Safety; Child welfare; Children; Clinical prediction tool; Contusions; Craniocerebral Trauma - etiology; Decision making; Decision Support Techniques; Female; Fractures; Head injuries; Health Personnel - psychology; Humans; Interdisciplinary aspects; Interviews; Judges & magistrates; Male; Middle Aged; Police; Probability; Protection; Qualitative Research; Reassurance; Reliance; Retinal Hemorrhage - etiology; Semi Structured Interviews; Social Work; Social workers; Thresholds; Training; Trauma; United Kingdom; Usefulness; Welfare state; Young Adult; United Kingdom; United Kingdom > UK; Qualitative research; Abusive head trauma; Child protection; Clinical prediction tool; Child physical abuse
• ISSN: 0145-2134; 1873-7757
• DOI: 10.1016/j.chiabu.2018.04.022

The validated Predicting Abusive Head Trauma (PredAHT) tool estimates the probability of abusive head trauma (AHT) based on combinations of six clinical features: head/neck bruising; apnea; seizures; rib/long-bone fractures; retinal hemorrhages. We aimed to determine the acceptability of PredAHT to child protection professionals. We conducted qualitative semi-structured interviews with 56 participants: clinicians (25), child protection social workers (10), legal practitioners (9, including 4 judges), police officers (8), and pathologists (4), purposively sampled across southwest United Kingdom. Interviews were recorded, transcribed and imported into NVivo for thematic analysis (38% double-coded). We explored participants’ evaluations of PredAHT, their opinions about the optimal way to present the calculated probabilities, and their interpretation of probabilities in the context of suspected AHT. Clinicians, child protection social workers and police thought PredAHT would be beneficial as an objective adjunct to their professional judgment, to give them greater confidence in their decisions. Lawyers and pathologists appreciated its value for prompting multidisciplinary investigations, but were uncertain of its usefulness in court. Perceived disadvantages included: possible over-reliance and false reassurance from a low score. Interpretations regarding which percentages equate to ‘low’, ‘medium’ or ‘high’ likelihood of AHT varied; participants preferred a precise % probability over these general terms. Participants would use PredAHT with provisos: if they received multi-agency training to define accepted risk thresholds for consistent interpretation; with knowledge of its development; if it was accepted by colleagues. PredAHT may therefore increase professionals’ confidence in their decision-making when investigating suspected AHT, but may be of less value in court.