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Ultrasound Evaluation of Skull Fractures in Children: A Feasibility Study

Riera, Antonio MD; Chen, Lei MD

doi: 10.1097/PEC.0b013e318252da3b
Original Articles

Objective The objective of this study was to investigate feasibility and evaluate test characteristics of bedside ultrasound for the detection of skull fractures in children with closed head injury (CHI).

Methods This was a prospective, observational study conducted in a pediatric emergency department of an urban tertiary care children’s hospital. A convenience sample of children younger than 18 years were enrolled if they presented with an acute CHI, and a computed tomography (CT) scan was performed. Ultrasound was performed by pediatric emergency medicine physicians with at least 1 month of training in bedside ultrasound. Ultrasound interpretation as either positive or negative for the presence of skull fracture was compared with attending radiologist CT scan dictation. Test characteristics (sensitivity, specificity, and positive and negative predictive values) were calculated.

Results Forty-six patients were enrolled. The median age was 2 years (range, 2 months to 17 years). Eleven patients (24%) were diagnosed with skull fractures on CT scan. Bedside ultrasound had a sensitivity of 82% (95% confidence interval [CI], 48%–97%), specificity of 94% (95% CI, 79%–99%), positive predictive value of 82% (95% CI, 48%–97%), and negative predictive value of 94% (95% CI, 79%–99%).

Conclusions Bedside ultrasonography can be used by pediatric emergency medicine physicians to detect skull fractures in children with acute CHI. Larger studies are needed to validate these findings. Future studies should investigate the role of this modality as an adjunct to clinical decision rules to reduce unnecessary CT scans in the evaluation of acute CHI in children.

From Yale University School of Medicine, New Haven, CT.

Disclosure: The authors declare no conflict of interest.

Reprints: Antonio Riera, MD, Yale University School of Medicine, 100 York St, Suite 1F, New Haven, CT 06511 (e-mail:

This study was supported in part by CTSA, grant KL2 RR024138 from the National Center for Research Resources, a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.

Abstract platform presentation: Eastern Society of Pediatric Research, March 2010, Philadelphia, PA. Poster presentation: Pediatric Academic Society, May 2010, Vancouver, British Columbia, Canada.

© 2012 Lippincott Williams & Wilkins, Inc.