Bedside Ultrasound Is a Valuable Alternative to CT Scans for Diagnosing Skull Fractures in Children With Traumatic Brain Injury

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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).

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