Ultrasound Effective Alternative to CT for Pediatric Skull Fractures

March 13, 2013

Emergency ultrasound may accurately diagnose cranial fractures in head-injured children with localized signs of head trauma compared with CT scanning.

Bedside emergency ultrasound of the skull may accurately diagnose cranial fractures in head-injured children with localized signs of head trauma compared with CT scanning, according to the results of a study published recently in Journal of Emergency Medicine.

Compared with CT, bedside ultrasound was performed with 100 percent sensitivity and 95 percent specificity for the diagnosis of pediatric skull fractures. The positive predictive value was 7.2 percent and the negative predictive value was 100 percent.

“Considering the simplicity of this examination, the minimal experience needed for an emergency physician to provide an accurate diagnosis and the lack of ionizing radiation, emergency physicians should consider this modality in the evaluation of pediatric head trauma,” Niccolò Parri, MD, of the Department of Pediatric Emergency Medicine at Anna Meyer Pediatric Hospital in Florence, Italy, said in an interview.

There is a great variation in protocol for diagnosing traumatic brain injury in children, and anywhere from 15 percent to 70 percent of children assessed in an emergency department may undergo CT scans, researchers said.

“Considering that CT scans are the source of two-thirds of the collective radiation from diagnostic imaging, ultrasound may provide another avenue to reduce exposure to ionizing radiation in health care systems worldwide,” Parri said. “An advantage of incorporating ultrasound into clinical practice guidelines is that it assists those physicians who do not frequently evaluate children with minor head trauma on a routine basis.”

In this study, Parri and colleagues enrolled 55 consecutive children presenting with head trauma. Children underwent cranial bedside ultrasound imaging performed by an emergency physician. The results of the ultrasound where then compared to those of a CT scan, and evaluated for sensitivity, specificity, and positive and negative predictive value. Based on the results, the researchers concluded that ultrasound study of the skull could be an adjunct to the clinical prediction rule described by the Pediatric Emergency Care Applied Research Network (PECARN).

“This will be particularly helpful for the intermediate-risk group as defined by PECARN, where strategies that include observation or CT may be appropriate,” Parri said. “Identification of a skull fracture by ultrasound in this intermediate group would indicate the patient is at higher risk of clinically important traumatic brain injury."