Ultrasound Evaluation of Skull Fractures in Children: A Feasibility Study

Pediatric Emergency Care, 05/07/2012

Riera A et al. – Bedside ultrasonography can be used by pediatric emergency medicine physicians to detect skull fractures in children with acute 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 18years 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 2years (range, 2months to 17years).
  • 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%).

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