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Published on: February 2, 2015
Diagnostic Accuracy of Ultrasonography for Identification of Skull Fracture in Children: A Systematic Review and
Reza Soltani Motlagh1, Lida Zare Lahijan2, Mehrdad Farrokhi1,3
1ERIS Research Institute, Tehran, Iran.
Insights
Ultrasonography shows high accuracy in diagnosing pediatric skull fractures, proving more effective for confirming than excluding the injury. However, potential bias in studies warrants cautious interpretation of these findings.
Area of Science:
- Pediatric imaging
- Diagnostic accuracy studies
- Medical ultrasonography
Background:
- Consensus is lacking regarding the diagnostic performance of ultrasonography for pediatric skull fractures.
- The accuracy of this imaging modality in children has been questioned, necessitating further investigation.
Purpose of the Study:
- To perform a pooled analysis exploring the diagnostic performance characteristics of ultrasonography for identifying skull fractures in children.
- To evaluate the sensitivity, specificity, and overall accuracy of ultrasonography in this pediatric population.
Main Methods:
- Systematic literature search of Web of Science, Medline, and Scopus databases.
- Data extraction of diagnostic parameters by two independent authors.
- Pooled analysis of diagnostic parameters using Meta-Disc software and Stata's MIDAS package.
Main Results:
- The pooled sensitivity for ultrasonography was 0.89 (95% CI: 0.86-0.92) and specificity was 0.97 (95% CI: 0.96-0.98).
- Positive likelihood ratio (PLR) was 23.21, negative likelihood ratio (NLR) was 0.13, and diagnostic odds ratio (DOR) was 208.89.
- Overall diagnostic accuracy of ultrasonography was estimated at 0.96.
Conclusions:
- Ultrasonography demonstrates high diagnostic accuracy for pediatric skull fractures, performing better for confirmation than exclusion.
- A high risk of bias in patient selection across studies limits generalizability.
- Results should be interpreted with caution due to identified limitations in the evidence base.
Introduction:
There is no consensus on the diagnostic performance of ultrasonography for identifying skull fractures in children, and the accuracy of this imaging modality in this age group has been questioned. This study performed a pooled analysis to explore the diagnostic performance characteristics of ultrasonography in this regard.
Methods:
Three databases, Web of Science, Medline, and Scopus, were systematically searched from their inception through August 2025. Data extraction of diagnostic parameters was performed by two independent authors. Pooled estimates of the diagnostic parameters were calculated using Meta-Disc software and the MIDAS package of Stata.
Results:
The estimated sensitivity of ultrasonography for detecting skull fracture in children was 0.89 (95% confidence interval (CI): 0.86-0.92), and the specificity was 0.97 (95% CI: 0.96-0.98). The estimated positive likelihood ratio (PLR) was 23.21 (95% CI: 14.84-36.32), while the negative likelihood ratio (NLR) was 0.13 (95% CI: 0.09-0.20). The diagnostic odds ratio (DOR) was 208.89 (95% CI: 112.68-387.27), and the estimated overall diagnostic accuracy of ultrasonography was 0.96.
Conclusion:
Ultrasonography demonstrated high diagnostic accuracy for identifying skull fractures in children, with evidence indicating stronger performance for confirmation than for exclusion. However, the high risk of bias in patient selection across the studies limits the generalizability of the evidence, and the results should therefore be interpreted with appropriate caution.
