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The Utility of Cranial Ultrasound for Detection of Intracranial Hemorrhage in Infants

Elkhunovich, Marsha MD*; Sirody, Joseph MS; McCormick, Taylor MD; Goodarzian, Fariba MD§; Claudius, Ilene MD

doi: 10.1097/PEC.0000000000000696
Original Articles

Objective The objective of this study was to evaluate the sensitivity and specificity of cranial ultrasound (CUS) for detection of intracranial hemorrhage (ICH) in infants with open fontanels.

Methods This was a retrospective study of infants younger than 2 years who had a CUS performed for the evaluation of potential ICH. We excluded patient with CUSs that were done for reasons related to prematurity, transplant or oncologic evaluations, routine follow-up or preoperative screen, or congenital and known perinatal anomalies. Two clinicians independently classified each of the patients with ICH into significant or insignificant based on the radiology reports.

Results Of 4948 CUS studies performed during the 5-year study period, 283 studies fit the inclusion criteria. Patient age ranged from 0 to 458 days, with a median of 33 days. There were 39 total cases of ICH detected, with 27 significant bleeds and 12 insignificant bleeds. Using computed tomography, magnetic resonance imaging, or clinical outcome as criterion standard, the overall ultrasound sensitivity and specificity for bleed were 67% (confidence interval [CI], 50%–81%) and 99% (CI, 97%–100%), respectively. For those with significant bleeds, the overall sensitivity was 81% (CI, 62%–94%), and for those with insignificant bleeds, it was 33% (CI, 1%–65%).

Conclusions The sensitivity of CUS is inadequate to justify its use as a screening tool for detection of ICH in young infants.

From the *Division of Emergency Medicine, Children’s Hospital Los Angeles, Los Angeles, CA; †Eastern Virginia Medical School, Norfolk, VA; and ‡Department of Emergency Medicine, Harbor UCLA Medical Center; §Department of Radiology, Children’s Hospital Los Angeles; and ∥Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, CA.

Research reported in this publication was partially supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award UL1TR000130 (formerly by the National Center for Research Resources, award UL1RR031986).

Portions of this data set have been previously presented at the Pediatric Academic Societies Conference, Vancouver, British Columbia, Canada, in May 2014, and the Society for Academic Emergency Medicine, Dallas, TX, in May 2014.

Disclosure: The authors declare no conflict of interest.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Reprints: Marsha Elkhunovich, MD, Division of Emergency Medicine, Children’s Hospital Los Angeles, 4650 W Sunset Blvd, Los Angeles, CA 90027 (e-mail:

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