Point-of-care ultrasound effectively identifies pediatric skull fractures

Image: PD

1.  Point-of-care ultrasound had 88% sensitivity and 97% specificity for skull fractures .

2.  Interobserver agreement among 17 clinicians trained in ultrasound was 0.86. 

Study Rundown: Head trauma is a very common, potentially devastating source of childhood injuries.  While computed tomography (CT) is the gold standard diagnostic test for the evaluation of head injuries, this imaging technique exposes patients to ionizing radiation and often requires young children to be sedated.  This study investigated the use of ultrasound as an alternative to CT in pediatric patients with head trauma, demonstrating that ultrasound offers a reliable, alternative imaging modality in the emergency setting. Skull ultrasound was found to have a sensitivity of 88% and specificity of 97%. Importantly, as utility of this test relies on the expertise of the clinician performing the evaluation, researchers also studied the effectiveness of a 1 hour, focused training session and found that novice sonographers were capable of developing necessary skills to effectively use this imaging modality.  This study was limited by its small sample size. Further evaluation is warranted to determine benefit of ultrasound when compared to CT in the evaluation of emergent pediatric skull fractures.

Click to read the study published today in Pediatrics

Relevant Reading: Ultrasound in the diagnosis of fractures in children

In-Depth [prospective, cohort study]: Researchers investigated ultrasound as an alternative imaging modality for the evaluation of skull fracture. 69 patients under 21 years of age who had a traumatic head injury were evaluated using both ultrasound and CT. 17 clinicians at 2 urban, Level II Pediatric Trauma Centers were trained for 1 hour with both didactic and hands-on training prior to study initiation. 8 skull fractures were identified within the study cohort. There were 3 discordant results between point-of-care ultrasound and CT, with 1 false negative result and 2 false positive results.  Sensitivity of-point-of care ultrasound was found to be 88% (95% CI: 53-98%) and specificity was 97% (95% CI: 89-99%).  Interobserver agreement between experienced and novice sonographers was found to be 0.86 (95% CI: 0.67-1.0).

By Emilia Hermann and Leah Carr

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