Diagnosing skull fracture in children with closed head injury using point-of-care ultrasound vs. computed tomography scan

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.

Diagnostic test accuracy of ultrasound for orbital cellulitis: A systematic review

“…For example, medical schools have also started incorporating POCUS into their undergraduate medical education [ 30 ]. POCUS is now being used to detect cranial hemorrhage in preterm infants [ 27 ] and skull fractures in toddlers [ 31 ]. POCUS has also been found to be beneficial in investigating orbital trauma as it can identify orbital fractures and correlates well with CT [ 32 ].…”

Diagnosis of Rib Fracture and Related Complications in Patients with Blunt Chest Wall Trauma Using Point-of-Care Ultrasound vs. Computed Tomography Scan

“…In addition, the residents who participated in this study attended a 2-day workshop on lung ultrasound. Each lung field was scanned in the mid-alveolar anterior intercostal space (2-4) and the medial axial intercostal space (6)(7)(8). The presence of any discontinuity in the periosteum of the rib bone indicated a fracture (Figure 1).…”

“…On the other hand, studies have shown that 33 -50% of rib fractures are not detected on chest radiography, rendering the prognosis of patients more complex and difficult to determine using simple radiographic images (5). Although chest CT scan is a highly sensitive and specific method for detecting even minor rib fractures and their complications while patients are lying down, patient management is still complicated with concerns about the high radiation dose, costs, and the impossibility of transferring critically ill patients to the radiology center (6)(7)(8).…”

“…Point-of-care ultrasound (POCUS), on the other hand, is a cheap and fast method applicable in patients with unstable conditions and can accelerate reaching an immediate diagnosis, especially in the emergency department (ED) (6)(7)(8) and where radiography and CT scans are not possible, such as rural or war zones, or in space voyages. However, extensive research is required to evaluate this method's power of gear fracture detection and its complications.…”

Skull and scalp ultrasound in children: a review

“…Возможности УС при переломах костей свода черепа. Высокая диагностическая точность УС в диагностике переломов костей свода черепа у детей подтверждена многими исследованиями [9][10][11][12][13][14][15][16][17][18][19][20][21]. В 2022 г. G. Alexandridis и соавт.…”