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J Pediatr. 2018 May;196:230-236.e2. doi: 10.1016/j.jpeds.2017.12.057. Epub 2018 Feb 28.

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

Author information

1
Department of Pediatric Emergency Medicine and Trauma Center, Meyer Children's Hospital, Firenze, Italy. Electronic address: niccolo.parri@meyer.it.
2
Emergency Department, Dixie Regional Medical Center, St. George, UT.
3
Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA.
4
Emergency Department, Bambino Gesù Children's Hospital, IRCCS Rome, Rome, Italy.
5
Department of Woman's and Child's Health, University of Padova, Padova, Italy.
6
Department of Emergency Medicine, Long Island Jewish Medical Center & Cohen Children's Medical Center, New Hyde Park, NY.
7
Department of Statistics G. Parenti, University of Florence and ISPO Cancer Prevention and Research Institute, Florence, Italy.
8
Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA; Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, CA.

Abstract

OBJECTIVES:

To determine the accuracy of skull point-of-care ultrasound (POCUS) for identifying fractures in children younger than 2 years of age with signs of head trauma, and the ability of POCUS to identify the type and depth of fracture depression.

STUDY DESIGN:

This was a multicenter, prospective, observational study of children younger than 2 years of age with nontrivial mechanisms of injury and signs of scalp/skull trauma. Patients were enrolled if they underwent computed tomography (CT). Patients underwent clinical evaluation, in addition to a cranial POCUS in the emergency department (ED). From the POCUS examinations, we documented whether fractures were present or absent, their location, characteristics, and depth. POCUS and CT findings were compared to calculate the diagnostic accuracy.

RESULTS:

We enrolled a convenience sample of 115 of 151 (76.1%) eligible patients. Of the 115 enrolled, 88 (76.5%) had skull fractures. POCUS had a sensitivity of 80 of 88 (90.9%; 95% CI 82.9-96.0) and a specificity of 23 of 27 (85.2%; 95% CI 66.3-95.8) for identifying skull fractures. Agreement between POCUS and CT to identify the type of fracture as linear, depressed, or complex was 84.4% (97 of 115) with a kappa of 0.75 (95% CI 0.70-0.84).

CONCLUSIONS:

POCUS performed by emergency physicians may identify the type and depth of fractures in infants with local physical signs of head trauma with substantial accuracy. Emergency physicians should consider POCUS as an adjunct to clinical evaluation and prediction rules for traumatic brain injuries in children younger than 2 years of age.

KEYWORDS:

head trauma; traumatic brain injury

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