Bedside Ultrasound Is a Valuable Alternative to CT Scans for Diagnosing Skull Fractures in Children With Traumatic Brain Injury
Traumatic brain injury (TBI) is one of the most common causes of morbidity and mortality worldwide. Nearly one in three TBIs will result in a skull fracture, which can damage the brain and its surrounding tissues, typically causing poor outcomes and complicating the recovery process. Skull fractures are usually diagnosed using computed tomography (CT) scans, a gold-standard brain imaging technique that uses x-rays to visualize the inside of the head. However, given the small-dose radiation exposure associated with x-rays, clinical guidelines discourage clinicians from overusing CT scans—especially in children, who are more sensitive to radiation. Furthermore, CT scans can be time- and cost-intensive, which may disproportionately burden families with lower financial resources.
To address these concerns, clinicians are seeking other viable techniques to diagnose skull fractures in children with TBI. A research team identified point-of-care ultrasound (POCUS) as one such promising alternative to CT scans. Unlike CT scans, imaging with POCUS is rapid, portable, noninvasive, low-cost, and, most importantly, free of radiation. Physicians use POCUS for many other clinical applications, but the effectiveness of POCUS as a diagnostic tool for skull fracture had not yet been studied.
The research team tested POCUS on 168 children (under age 14) who were admitted to the emergency department with a TBI and who were suspected to have a skull fracture. After receiving POCUS imaging, each participant underwent a CT scan for comparison. The researchers analyzed each scan, finding that POCUS correctly diagnosed skull fractures in about 82% of children who did have skull fractures and correctly ruled out skull fractures in 100% of children who did not have skull fractures. POCUS was 98.8% accurate compared to CT scans.
These findings strongly suggest that POCUS is a viable alternative to CT scans for children with TBI who are suspected to have a skull fracture. Critically, use POCUS to rapidly diagnose skull fractures in the emergency department adheres to clinical guidelines that recommend reducing CT-related radiation exposure as often as possible. Further research is necessary to determine best practices for administering POCUS in emergency settings.
Dehbozorgi A, Mousavi-Roknabadi RS, Hosseini-Marvast SR, et al. Diagnosing skull fracture in children with closed head injury using point-of-care ultrasound vs. computed tomography scan. European Journal of Pediatrics. (October 2020).