Point of Care Ultrasound in Detection of Brain Hemorrhage and Skull Fracture Following Pediatric Head Trauma; a Diagnostic Accuracy Study

Abstract

Introduction: Head trauma is a common reason for emergency department visits worldwide; many of which involve young children. Currently, the standard imaging test for head trauma patients is Noncontrasted Computed tomography, even though it employs ionizing radiation. We sought to determine if head ultrasound, as a fast and safe modality, can guide diagnosis and treatment of children in emergency settings.  Methods: In this cross-sectional study, head CT-scans and emergency head ultrasounds were performed on head trauma children referred to the emergency departments of Firouzgar and Besat Hospitals, Tehran, Iran, from September 2018 to May 2019. The findings of the two modality were separately evaluated, and used to estimate US diagnostic accuracy statistics. Results: 538 patients with the mean age of 5.6 +- 4.9 (0-18) years were studied (54.8% male). Sensitivity and specificity of bedside sonography in detection of hemorrhage below the age of 2 were 85.71 (42.13-99.64) and 97.99 (94.23-99.58).Between 2 and 6 years old 80.00 (51.91-95.67) and 97.97 (94.88-99.44), and above the age of 6 were 46.67 (21.27-73.41) and 92.90 (87.66-96.40), respectively. For diagnosing skull fractures, sensitivity and specificity were 92.31 (84.01-97.12) and 95.87 (93.62-97.50), respectively. Cohen’s kappa coefficient varied greatly for different findings from 0.363 to 0.825, indicating different agreement rates for each. Conclusion: Based on our findings, emergency ultrasound can play a greater role in the initial management of head trauma children especially as a triage test or in disasters.  Â

Keywords

• Emergency Medicine
• Pediatrics
• Craniocerebral Trauma
• Skull Fractures
• Intracranial Hemorrhages
• Ultrasonography