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Published on: February 2, 2015
Ultrasound evaluation of skull fractures in children: a feasibility study
1Yale University School of Medicine, New Haven, CT 06511, USA. Antonio.riera@yale.edu
Insights
Bedside ultrasound effectively detects skull fractures in children with closed head injury (CHI), showing high sensitivity and specificity. This imaging technique shows promise for evaluating pediatric CHI cases.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Ultrasound Technology
Background:
- Pediatric head injuries necessitate accurate fracture detection.
- Computed tomography (CT) is the standard for diagnosing skull fractures but involves radiation exposure.
- Minimally invasive diagnostic tools are sought for evaluating pediatric head trauma.
Purpose of the Study:
- To assess the feasibility of bedside ultrasound for detecting skull fractures in children with closed head injury (CHI).
- To evaluate the diagnostic accuracy, including sensitivity and specificity, of ultrasound compared to CT scans.
Main Methods:
- Prospective observational study in a pediatric emergency department.
- Enrolled children (<18 years) with acute CHI undergoing CT scan.
- Bedside ultrasound performed by trained pediatric emergency medicine physicians; results compared to radiologist CT interpretation.
Main Results:
- Forty-six children were analyzed; 11 (24%) had skull fractures confirmed by CT.
- Bedside ultrasound demonstrated a sensitivity of 82% and specificity of 94%.
- Positive and negative predictive values were also high, at 82% and 94%, respectively.
Conclusions:
- Bedside ultrasonography is a feasible method for pediatric emergency physicians to detect skull fractures in children with CHI.
- Findings suggest ultrasound could potentially reduce the need for CT scans in evaluating pediatric head injuries.
- Larger studies are recommended to validate these results and explore ultrasound's role alongside clinical decision rules.
Objective:
The objective of this study was to investigate feasibility and evaluate test characteristics of bedside ultrasound for the detection of skull fractures in children with closed head injury (CHI).
Methods:
This was a prospective, observational study conducted in a pediatric emergency department of an urban tertiary care children's hospital. A convenience sample of children younger than 18 years were enrolled if they presented with an acute CHI, and a computed tomography (CT) scan was performed. Ultrasound was performed by pediatric emergency medicine physicians with at least 1 month of training in bedside ultrasound. Ultrasound interpretation as either positive or negative for the presence of skull fracture was compared with attending radiologist CT scan dictation. Test characteristics (sensitivity, specificity, and positive and negative predictive values) were calculated.
Results:
Forty-six patients were enrolled. The median age was 2 years (range, 2 months to 17 years). Eleven patients (24%) were diagnosed with skull fractures on CT scan. Bedside ultrasound had a sensitivity of 82% (95% confidence interval [CI], 48%-97%), specificity of 94% (95% CI, 79%-99%), positive predictive value of 82% (95% CI, 48%-97%), and negative predictive value of 94% (95% CI, 79%-99%).
Conclusions:
Bedside ultrasonography can be used by pediatric emergency medicine physicians to detect skull fractures in children with acute CHI. Larger studies are needed to validate these findings. Future studies should investigate the role of this modality as an adjunct to clinical decision rules to reduce unnecessary CT scans in the evaluation of acute CHI in children.
