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State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
Ability of emergency ultrasonography to detect pediatric skull fractures: a prospective, observational study
Niccolò Parri1, Bradley J Crosby, Casey Glass
1Department of Pediatric Emergency Medicine, Anna Meyer Pediatric Hospital, Florence, Italy.
Insights
Bedside ultrasound accurately diagnoses pediatric skull fractures, offering 100% sensitivity and 95% specificity compared to CT scans. This radiation-free imaging is a valuable tool for evaluating head injuries in children.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Ultrasound Technology
Background:
- Blunt head trauma is a frequent cause of pediatric emergency department visits.
- Computed tomography (CT) scans, often used for diagnosis, involve ionizing radiation and may require sedation.
- Accurate and safe diagnostic methods for pediatric head injuries are crucial.
Purpose of the Study:
- To evaluate the diagnostic accuracy of bedside emergency department ultrasound for identifying skull fractures in pediatric patients.
- To compare ultrasound findings with head CT scan results.
- To determine the sensitivity, specificity, and predictive values of ultrasound in diagnosing pediatric skull fractures.
Main Methods:
- A prospective study involving pediatric patients with head trauma requiring CT scans.
- Bedside cranial ultrasound imaging performed by emergency physicians.
- Comparison of ultrasound results against confirmed CT scan diagnoses.
Main Results:
- Ultrasound demonstrated 100% sensitivity and 95% specificity for detecting skull fractures compared to CT scans.
- Positive predictive value was 97.2% and negative predictive value was 100%.
- The findings indicate high accuracy for ultrasound in this pediatric population.
Conclusions:
- Bedside ultrasound is an accurate diagnostic tool for pediatric skull fractures.
- This method avoids ionizing radiation and is simple to perform.
- Emergency physicians can consider ultrasound as a valuable alternative or adjunct in evaluating pediatric head trauma.
Background:
Blunt head trauma is a common reason for medical evaluation in the pediatric Emergency Department (ED). The diagnostic work-up for skull fracture, as well as for traumatic brain injury, often involves computed tomography (CT) scanning, which may require sedation and exposes children to often-unnecessary ionizing radiation.
Objectives:
Our objective was to determine if bedside ED ultrasound is an accurate diagnostic tool for identifying skull fractures when compared to head CT.
Methods:
We present a prospective study of bedside ultrasound for diagnosing skull fractures in head-injured pediatric patients. A consecutive series of children presenting with head trauma requiring CT scan was enrolled. Cranial bedside ultrasound imaging was performed by an emergency physician and compared to the results of the CT scan. The primary outcome was to identify the sensitivity, specificity, and predictive values of ultrasound for skull fractures when compared to head CT.
Results:
Bedside emergency ultrasound performs with 100% sensitivity (95% confidence interval [CI] 88.2-100%) and 95% specificity (95% CI 75.0-99.9%) when compared to CT scan for the diagnosis of skull fractures. Positive and negative predictive values were 97.2% (95% CI 84.6-99.9%) and 100% (95% CI 80.2-100%), respectively.
Conclusions:
Compared to CT scan, bedside ultrasound may accurately diagnose pediatric skull fractures. Considering the simplicity of this examination, the minimal experience needed for an Emergency Physician to provide an accurate diagnosis and the lack of ionizing radiation, Emergency Physicians should consider this modality in the evaluation of pediatric head trauma. We believe this may be a useful tool to incorporate in minor head injury prediction rules, and warrants further investigation.
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