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Diagnosing skull fracture in children with closed head injury using point-of-care ultrasound vs. computed tomography
Afsaneh Dehbozorgi1, Razieh Sadat Mousavi-Roknabadi1, Seyed Rouhollah Hosseini-Marvast2,3
1Emergency Medicine Department, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
Point-of-care ultrasound (POCUS) accurately diagnoses skull fractures in children with head injuries. This portable tool, used by emergency physicians, shows high precision compared to CT scans, aiding patient management.
Area of Science:
- Pediatric emergency medicine
- Diagnostic imaging
- Trauma care
Background:
- Traumatic brain injury is a critical complication in pediatric trauma.
- Accurate diagnosis of skull fractures in children is essential for appropriate management.
- Existing evidence on point-of-care ultrasound (POCUS) for pediatric skull fractures in emergency settings is limited.
Purpose of the Study:
- To evaluate the diagnostic accuracy of POCUS for skull fractures in children with closed head injuries.
- To compare POCUS performance against computed tomography (CT) scan, the gold standard.
- To assess the utility of POCUS as a management tool in pediatric head trauma.
Main Methods:
- Prospective, cross-sectional study involving children (0-14 years) with suspected skull fractures after closed head injury.
- POCUS performed by emergency medicine residents.
- Comparison of POCUS results with CT scan findings reported by radiologists.
- Calculation of diagnostic test metrics including sensitivity, specificity, and accuracy.
Main Results:
- POCUS demonstrated high diagnostic accuracy for skull fractures in children (98.8%).
- Sensitivity was 81.8% and specificity was 100%.
- Positive and negative predictive values were 100% and 98.7%, respectively.
Conclusions:
- POCUS is a highly precise diagnostic tool for skull fractures in pediatric patients with closed head injuries.
- Portable ultrasonography, performed by emergency physicians, can be effectively integrated into the management of these patients.
- POCUS offers a valuable alternative or adjunct to CT scans in evaluating pediatric head trauma.
Abstract:
Diagnostic and therapeutic interventions in children for traumatic brain injury, which is known as the most important complication in trauma, require special attention. This study aimed to evaluate the accuracy of point-of-care ultrasound (POCUS) in diagnosing skull fracture in children with closed head injury in comparison with computed tomography (CT) scan. The current prospective cross-sectional study was conducted on children (0-14 years old), who were referred to the emergency department of a general teaching hospital in Shiraz, southern Iran (January-March 2018), with close head injury and were suspected of bone fracture. The participants were selected using a convenience sampling. The results of POCUS performed by emergency medicine (EM) residents were compared with the results of CT scan, which was reported by radiologists and considered a gold standard. Then, diagnostic tests were calculated. A total of 168 children were enrolled, with the mean ± standard deviation age of 6.21 ± 3.99. The most affected areas in the skull were the frontal (34.5%) and occipital areas (33.3%). POCUS had a sensitivity and specificity of 81.8% (95%CI, 48.2-97.7%) and 100% (95%CI, 97.7-100%), respectively. Positive and negative predictive values were 100% and 98.7%, with an accuracy of 98.8% in comparison with CT scan in the diagnosis of skull fracture.Conclusion: The results showed that POCUS with a portable ultrasonography machine, performed by the EM's physicians, have high diagnostic precision and can be considered a tool in the management of patients with closed head injury. What is Known: • Some studies have investigated the accuracy of ultrasound in diagnosing skull bone fractures in children with closed head injury, but before conducting this survey, no definite evidence recommended POCUS for skull fracture in children with closed head trauma in the ED. What is New: • POCUS with a portable ultrasonography machine, performed by the EM's physicians, has high diagnostic precision and can be considered a tool in the management of patients with closed head injury.
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