Accuracy of Bedside Ultrasound for the Diagnosis of Skull Fractures in Children Aged 0 to 4 Years

Abstract

Objectives The aim of this study was to investigate the accuracy of bedside ultrasound (US) performed by emergency physicians for diagnosing skull fractures in children 0 to 4 years old compared with the accuracy of head computed tomography (CT). We also sought to investigate characteristics and precautions associated with US. Methods This single-center prospective study involved children 0 to 4 years old who had a history of head trauma. Bedside US was performed by emergency medicine physicians, and the results were compared with CT scan interpretations provided by attending radiologists. The accuracy of US for the diagnosis of skull fractures was calculated, and the errors were reviewed. Results A total of 87 patients were enrolled. Skull fracture was present in 13 patients (14.9%), according to CT. Bedside US had a sensitivity and specificity of 76.9% (95% confidence interval [CI], 46.0%–93.8%) and 100% (95% CI, 93.9%–100%), respectively. Overall positive predictive value was 100% (95% CI, 65.5%–100%), and negative predictive value was 96.1% (95% CI, 88.3%–99.0%). Three false-negative cases were observed. Conclusions Bedside US performed by emergency medicine physicians with short focused US training is a useful tool for diagnosing skull fractures in children 0 to 4 years of age. However, there were 3 false-negative cases. A meticulous examination is needed in the area adjacent to the orbital wall and skull base.

Evidence base for point-of-care ultrasound (POCUS) for diagnosis of skull fractures in children: a systematic review and meta-analysis

“…4 11 Although there was overall a high sensitivity and specificity of the test, this pretest probability has to be for accounted for. The study of Choi et al 39 did not apply clinical decision rules and this factor possibly led to a lower number of fractures; this could also have occurred in the other studies with a relatively low number of fractures. [36][37][38] Third, two studies included patients older than 18 years.…”

“…34 35 Five studies were at risk of bias in the domain 'patient selection'. [36][37][38][39][40] One study was at risk of bias in the domain 'flow and timing' because the time interval between POCUS and CT was unclear. 36 An overview is presented in table 1.…”

“…34 40 In four studies the ultrasonographer had varying levels of experience. [37][38][39][40] Two studies did not report the previous experience of the sonographers. 34 36 One study reported that the sonographers had 16 hours of experience.…”

“…34 37 39 42 43 Five of the seven studies were at risk of bias because they studied a convenience sample; this might lead to underrepresentation of subgroups. [36][37][38][39][40] The study of Weinberg et al 36 has a remarkably high sensitivity and specificity of 100%. This may be explained due to the relatively small sample size of 21 patients that might overestimate the results.…”

Neonatal head injuries: A prospective Paediatric Research in Emergency Departments International Collaborative cohort study

“…In our study, four neonates underwent transfontanelle ultrasound with two showing TBI on ultrasound, which was confirmed by CT scan. The role of ultrasound as a safe (lack of radiation), cost‐effective tool in the diagnosis and management of TBI and skull fractures remains to be determined.…”