Bedside US diagnoses pediatric skull fractures w/o radiation or sedation

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Bedside ultrasound can accurately diagnose pediatric skull fractures, offering an alternative to the radiation and sedation involved in CT scanning of children, according to a study published in the Journal of Emergency Medicine.

“Considering the simplicity of [bedside ultrasound], 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,” wrote Niccolò Parri, MD, of Anna Meyer Pediatric Hospital, Florence, Italy, and colleagues.

Results were based on a prospective study of a consecutive series of children presenting with head trauma requiring a CT scan. A total of 55 patients, enrolled from July 9 to Dec. 1, 2010, were ultimately included in the analysis, and all received a cranial bedside ultrasound exam performed by an emergency physician.

Parri and colleagues reported that bedside emergency ultrasound performed with 100 percent sensitivity and 95 percent specificity when compared to CT for the diagnosis of skull fractures. Positive and negative predictive values were 97.2 percent and 100 percent, respectively. One patient was identified as a false positive on ultrasound upon review of the CT scan.

“Anatomic accuracy was so precise that we were able to identify structures such as vascular channels, sutures, and neuronal foramina, and distinguish in all cases except one these anatomic variants from fractures,” wrote the authors.

They noted that skull fractures are more predictive of traumatic brain injury in children than scalp swelling or vomiting, and that the presence of skull fractures in children increases the likelihood of intracranial injury from four to twenty times. Most intracranial injuries in asymptomatic infants are diagnosed because of evidence of skull fracture, according to Parri and colleagues.

They argued ultrasound could be a useful tool to incorporate in minor head injury prediction rules and that the technique warrants further investigation.