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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)230-236
Number of pages7
JournalJournal of Pediatrics
Volume196
DOIs
Publication statusPublished - May 2018
Externally publishedYes

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Point-of-Care Systems
Skull Fractures
Tomography
Craniocerebral Trauma
Skull
Emergencies
Physicians
Decision Support Techniques
Wounds and Injuries
Scalp
Observational Studies
Hospital Emergency Service
Prospective Studies

Cite this

Parri, N., Crosby, B. J., Mills, L., Soucy, Z., Musolino, A. M., Da Dalt, L., ... Kuppermann, N. (2018). Point-of-Care Ultrasound for the Diagnosis of Skull Fractures in Children Younger Than Two Years of Age. Journal of Pediatrics, 196, 230-236. https://doi.org/10.1016/j.jpeds.2017.12.057

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; Soucy, Zachary; Musolino, Anna Maria; Da Dalt, Liviana; Cirilli, Angela; Grisotto, Laura; Kuppermann, Nathan.

In: Journal of Pediatrics, Vol. 196, 05.2018, p. 230-236.

Research output: Contribution to journalArticle

Parri, N, Crosby, BJ, Mills, L, Soucy, Z, Musolino, AM, Da Dalt, L, Cirilli, A, Grisotto, L & Kuppermann, N 2018, 'Point-of-Care Ultrasound for the Diagnosis of Skull Fractures in Children Younger Than Two Years of Age', Journal of Pediatrics, vol. 196, pp. 230-236. https://doi.org/10.1016/j.jpeds.2017.12.057
Parri, Niccolò ; Crosby, Bradley J ; Mills, Lisa ; Soucy, Zachary ; Musolino, Anna Maria ; Da Dalt, Liviana ; Cirilli, Angela ; Grisotto, Laura ; Kuppermann, Nathan. / Point-of-Care Ultrasound for the Diagnosis of Skull Fractures in Children Younger Than Two Years of Age. In: Journal of Pediatrics. 2018 ; Vol. 196. pp. 230-236.
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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.",
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T1 - Point-of-Care Ultrasound for the Diagnosis of Skull Fractures in Children Younger Than Two Years of Age

AU - Parri, Niccolò

AU - Crosby, Bradley J

AU - Mills, Lisa

AU - Soucy, Zachary

AU - Musolino, Anna Maria

AU - Da Dalt, Liviana

AU - Cirilli, Angela

AU - Grisotto, Laura

AU - Kuppermann, Nathan

N1 - Copyright © 2017 Elsevier Inc. All rights reserved.

PY - 2018/5

Y1 - 2018/5

N2 - 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.

AB - 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.

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DO - 10.1016/j.jpeds.2017.12.057

M3 - Article

VL - 196

SP - 230

EP - 236

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

ER -