Point-of-Care Ultrasound for the Diagnosis of Skull Fractures in Children Younger Than Two Years of Age

Parri, Niccolò; Crosby, Bradley J.; Mills, Lisa D.; Soucy, Zachary; Musolino, Anna Maria; Dalt, Liviana Da; Cirilli, Angela; Grisotto, Laura; Kuppermann, Nathan

doi:10.1016/j.jpeds.2017.12.057

Cited by 36 publications

(66 citation statements)

References 48 publications

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“…On the other hand, the prevalence of skull fracture amongst 168 patients in this study was 6.6%, while in other studies, this number varied between 11% in the study by Rabiner et al [ 9 ] and 76.5% in Parri et al [ 20 ]. It seems that stricter entry criteria in those studies might have led to enrolling patients with higher risk of skull fracture and traumatic brain injury, e.g., in Parri et al study [ 20 ], which considered only hematoma as the point of fracture. Therefore, the mentioned studies obtained a higher rate of skull fractures.…”

Section: Discussioncontrasting

confidence: 69%

“…The specificity of this modality in the current study was 100%, while in the study by Parri et al [ 20 ], which had the highest number of sample size before this study, it was reported to be 85.2%. This significant difference might be due to the number of patients diagnosed with skull fracture in the mentioned study, and the number might be closer to reality.…”

Section: Discussioncontrasting

confidence: 53%

“…Another difference was that in previous studies, emergency radiologist or EM specialist who conducted POCUS had been trained between an hour to a month [ 9 , 11 , 20 ]. In contrary, POCUS was conducted by the first year EM residents in our study.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Discussioncontrasting

confidence: 69%

Section: Discussioncontrasting

confidence: 53%

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

et al. 2020

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“…While previous guidelines recommended skull X-rays in children with isolated SH, based on evidence showing the association between skull fracture and TBI, other studies have shown that up to 50% of TBI can occur in the absence of a skull fracture 9 22 25–28. Point-of-care ultrasound is increasingly replacing skull X-rays for the identification of skull fractures in children with traumatic SHs, showing good accuracy for fractures identification compared with CT scan 29 30. In addition, this test is not invasive, not associated with radiation and can define the characteristics of a fracture (depressed or complex) 29.…”

Section: Discussionmentioning

confidence: 99%

“…Point-of-care ultrasound is increasingly replacing skull X-rays for the identification of skull fractures in children with traumatic SHs, showing good accuracy for fractures identification compared with CT scan 29 30. In addition, this test is not invasive, not associated with radiation and can define the characteristics of a fracture (depressed or complex) 29. However, its role as a screening tool to risk stratify patients for TBI in the era of high-quality head injury prediction rules remains to be clarified.…”

Section: Discussionmentioning

confidence: 99%

Traumatic brain injury in young children with isolated scalp haematoma

Bressan

Kochar

Oakley³

et al. 2019

Arch Dis Child

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ObjectiveDespite high-quality paediatric head trauma clinical prediction rules, the management of otherwise asymptomatic young children with scalp haematomas (SH) can be difficult. We determined the risk of intracranial injury when SH is the only predictor variable using definitions from the Pediatric Emergency Care Applied Research Network (PECARN) and Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) head trauma rules.DesignPlanned secondary analysis of a multicentre prospective observational study.SettingTen emergency departments in Australia and New Zealand.PatientsChildren <2 years with head trauma (n=5237).InterventionsWe used the PECARN (any non-frontal haematoma) and CHALICE (>5 cm haematoma in any region of the head) rule-based definition of isolated SH in both children <1 year and <2 years.Main outcome measuresClinically important traumatic brain injury (ciTBI; ie, death, neurosurgery, intubation >24 hours or positive CT scan in association with hospitalisation ≥2 nights for traumatic brain injury).ResultsIn children <1 year with isolated SH as per PECARN rule, the risk of ciTBI was 0.0% (0/109; 95% CI 0.0% to 3.3%); in those with isolated SH as defined by the CHALICE, it was 20.0% (7/35; 95% CI 8.4% to 36.9%) with one patient requiring neurosurgery. Results for children <2 years and when using rule specific outcomes were similar.ConclusionsIn young children with SH as an isolated finding after head trauma, use of the definitions of both rules will aid clinicians in determining the level of risk of ciTBI and therefore in deciding whether to do a CT scan.Trial registration numberACTRN12614000463673.

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Traumatic Brain Injury

Gooldy

Adelson

2023

Pediatric Neurosurgery Board Review

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Point-of-Care Ultrasound for the Diagnosis of Skull Fractures in Children Younger Than Two Years of Age

Cited by 36 publications

References 48 publications

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

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

Traumatic brain injury in young children with isolated scalp haematoma

Traumatic Brain Injury

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