TABLE 1.
Inclusion Criteria: All 4 Criteria Must Be Met | Definition |
---|---|
30–364 d of agea AND | Self-explanatory |
Well-appearing AND | Defined as GCS score of 13–15 OR by description of the attending physician when no GCS score assigned |
Temperature <38.3°C AND | Defined as no measured temperature ≥38.3°C in the previous 24 h |
No history of trauma AND | History of trauma not given by caretaker as the reason for seeking medical care. If history of trauma was later provided by caretakers, this was not considered to be a history of trauma for purposes of eligibility |
Seeking medical evaluation for 1 of the following symptoms | ALTE as defined by the National Institutes of Health17 |
(1) ALTE/apnea | Vomiting without diarrhea defined as >4 episodes of vomiting in the previous 24 h OR ≥3 episodes of vomiting per 24 h for the previous 48 h |
(2) vomiting without diarrhea | |
(3) seizures or seizurelike activity | |
(4) soft tissue swelling of the scalp | |
(5) bruising | |
(6) other nonspecific neurologic symptom not described above, such as lethargy, fussiness, or poor feeding |
GCS; Glasgow Coma Scale Score.
Children <30 d of age were excluded because the validation of PIBIS was part of a larger study evaluating the use of serum biomarkers to identify brain injury. Because serum biomarkers of brain injury are often abnormal in healthy infants <30 d of age, neonates were excluded from the entire study.