Diagnostic Testing for Acute Head Injury in Children: When Are Head Computed Tomography and Skull Radiographs Indicated?

Quayle, Kimberly S.; Jaffe, David M.; Kuppermann, Nathan; Kaufman, Bruce A.; Lee, Benjamin C. P.; Park, T. S.; McAlister, William H.

doi:10.1542/peds.99.5.e11

Cited by 233 publications

(207 citation statements)

References 26 publications

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“…This study documented a little high incidence of contusions, and ICH of 22% and 20%, respectively, where the previous reports declared low [2,3,6], this might reflect the severity, and the selectivity of the cases of head traumas included in this study. In another study the incidence of contusion and ICH were 13% and 25% respectively [7].…”

Section: Intracerebral Hematoma (Ich) and Brainsupporting

confidence: 52%

“…As per the various literatures, RTA is the most common etiology in head injury cases and third and forth decade of life is commonest age group with male gender because they are involved in economic and social life [2][3][4][5][6][7][8][9].…”

Section: Discussionmentioning

confidence: 99%

“…Various literatures have estimated that nearly 1.6 million cranial injuries occur in the United States each year, resulting in over 50,000 -60,000 deaths and over 70,000 -80,000 patients with lifelong neurological deficits [2][3][4]. The diagnosis and management of head trauma have been changed significantly with the wide availability of ct scan since its inception in 1970s [1,2], this study demonstrates the importance of ct scan in acute head trauma, showing the different intracranial consequences and their frequencies have been correlated with age, sex, and the presence of a skull fracture [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Significance of computed tomography scans in head injury

Tomar¹,

Bhargava²,

Reddy³

2013

OJCD

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where in 82% of cases males were involved , and most of the injured people belong to the first three decades of life, the main cause being road traffic accident which is growing in incidence in this 21 st century. Most of the cases which were studied showed skull fractures, which indicates that there has been significant trauma and in a single case more than one pathology related to cranium has been seen. The most common post traumatic consequences found in the study of adults are contusions, brain edema and intracerebral hematomas, while other sequelae such as subarachnoid hematomas, subdural hematomas and extradural hematomas are encountered less. Diffuse and focal cerebral edema was being the most common pathology following trauma in children. Conclusion: CT scanning is the primary modality of choice in the diagnostic work up of patients with acute head trauma for identifying the various intracranial consequences following head injury especially within 48 hours which helps in the initial assessment, treatment planning, follow up and long term management of patients.

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Section: Intracerebral Hematoma (Ich) and Brainsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Significance of computed tomography scans in head injury

Tomar¹,

Bhargava²,

Reddy³

2013

OJCD

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“…1 It is estimated that 16% of children with nontrivial head injuries may have skull fractures, and the presence of a skull fracture is associated with a fourfold increased risk of an underlying intracranial injury. 2 The gold standard diagnostic test to evaluate for skull fracture and intracranial hemorrhage is head computed tomography (CT), which is highly sensitive for identification of children with intracranial injuries requiring acute intervention. 3 However, CT imaging exposes developing brains to ionizing radiation [4][5][6][7] and may require sedation in young children.…”

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confidence: 99%

Accuracy of Point-of-Care Ultrasound for Diagnosis of Skull Fractures in Children

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Head injuries and concern for skull fracture are common in pediatrics. Point-of-care ultrasound is an imaging tool that can be used to diagnose fractures. However, there are scant data regarding the accuracy of point-ofcare ultrasound in skull fracture diagnosis. WHAT THIS STUDY ADDS:Clinicians with focused point-of-care ultrasound training are able to diagnose skull fractures in children with high specificity. Ultrasound may be valuable to diagnose skull fractures in children at the point of care. abstract OBJECTIVE: To determine the test performance characteristics for point-of-care ultrasound performed by clinicians compared with computed tomography (CT) diagnosis of skull fractures. METHODS:We conducted a prospective study in a convenience sample of patients #21 years of age who presented to the emergency department with head injuries or suspected skull fractures that required CT scan evaluation. After a 1-hour, focused ultrasound training session, clinicians performed ultrasound examinations to evaluate patients for skull fractures. CT scan interpretations by attending radiologists were the reference standard for this study. Pointof-care ultrasound scans were reviewed by an experienced sonologist to evaluate interobserver agreement.RESULTS: Point-of-care ultrasound was performed by 17 clinicians in 69 subjects with suspected skull fractures. The patients' mean age was 6.4 years (SD: 6.2 years), and 65% of patients were male. The prevalence of fracture was 12% (n = 8). Point-of-care ultrasound for skull fracture had a sensitivity of 88% (95% confidence interval [CI]: 53%-98%), a specificity of 97% (95% CI: 89%-99%), a positive likelihood ratio of 27 (95% CI: 7-107), and a negative likelihood ratio of 0.13 (95% CI: 0.02-0.81). The only false-negative ultrasound scan was due to a skull fracture not directly under a scalp hematoma, but rather adjacent to it. The k for interobserver agreement was 0.86 (95% CI: 0.67-1.0). CONCLUSIONS:Clinicians with focused ultrasound training were able to diagnose skull fractures in children with high specificity. Pediatrics

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“…[1][2][3][4] Among children with minor head trauma and abnormal neuroimaging, skull fractures are the most common traumatic finding. [5][6][7] Children with isolated skull fractures, defined as a skull fracture without intracranial hemorrhage, are at exceedingly low risk for clinical decompensation. [8][9][10][11][12] Despite this low risk, hospitalization rates for children with isolated skull fractures approaches 80% nationally.…”

mentioning

confidence: 99%

A QI Initiative to Reduce Hospitalization for Children With Isolated Skull Fractures

Lyons¹,

Stack²,

Monuteaux³

et al. 2016

Pediatrics

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BACKGROUND AND OBJECTIVE: Although children with isolated skull fractures rarely require acute interventions, most are hospitalized. Our aim was to safely decrease the hospitalization rate for children with isolated skull fractures. METHODS: We designed and executed this multifaceted quality improvement (QI) initiative between January 2008 and July 2015 to reduce hospitalization rates for children ≤21 years old with isolated skull fractures at a single tertiary care pediatric institution. We defined an isolated skull fracture as a skull fracture without intracranial injury. The QI intervention consisted of 2 steps: (1) development and implementation of an evidence-based guideline, and (2) dissemination of a provider survey designed to reinforce guideline awareness and adherence. Our primary outcome was hospitalization rate and our balancing measure was hospital readmission within 72 hours. We used standard statistical process control methodology to assess change over time. To assess for secular trends, we examined admission rates for children with an isolated skull fracture in the Pediatric Health Information System administrative database. RESULTS: We identified 321 children with an isolated skull fracture with a median age of 11 months (interquartile range 5–16 months). The baseline admission rate was 71% (179/249, 95% confidence interval, 66%–77%) and decreased to 46% (34/72, 95% confidence interval, 35%–60%) after implementation of our QI initiative. No child was readmitted after discharge. The admission rate in our secular trend control group remained unchanged at 78%. CONCLUSIONS: We safely reduced the hospitalization rate for children with isolated skull fractures without an increase in the readmissions.

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Diagnostic Testing for Acute Head Injury in Children: When Are Head Computed Tomography and Skull Radiographs Indicated?

Cited by 233 publications

References 26 publications

Significance of computed tomography scans in head injury

Significance of computed tomography scans in head injury

Accuracy of Point-of-Care Ultrasound for Diagnosis of Skull Fractures in Children

A QI Initiative to Reduce Hospitalization for Children With Isolated Skull Fractures

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