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

Maryam Masaeli, Mojtaba Chahardoli, Sepehr Azizi, Babak Shekarchi, Foroogh Sabzghabaei, Nima Shekar Riz Fomani, Mehdi Azarmnia, Mahdis Abedi
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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.

 

 


Keywords

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

References

Faul M, Wald MM, Xu L, Coronado VG. Traumatic brain injury in the United States; emergency department visits, hospitalizations, and deaths, 2002-2006. 2010.

Ling G, Ecklund J, Bandak F. Brain injury from explosive blast: description and clinical management. Handbook of clinical neurology. 127: Elsevier; 2015. p. 173-80.

Miller SC, Whitehead CR, Otte CN, Wells TS, Webb TS, Gore RK, et al. Risk for broad-spectrum neuropsychiatric disorders after mild traumatic brain injury in a cohort of US Air Force personnel. Occup Environ Med. 2015;72(8):560-6.

Norris JN, Smith S, Harris E, Labrie DW, Ahlers ST. Characterization of acute stress reaction following an IED blast-related mild traumatic brain injury. Brain injury. 2015;29(7-8):898-904.

Papa L, Goldberg S. Head trauma. Rosen's Emergency Medicine: Concepts and Clinical Practice 9th ed Philadelphia, PA: Elsevier. 9th ed2018. p. 313.

Kuppermann N, Holmes JF, Dayan PS, Hoyle JD, Atabaki SM, Holubkov R, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. The Lancet. 2009;374(9696):1160-70.

Ro YS, Shin SD, Holmes JF, Song KJ, Park JO, Cho JS, et al. Comparison of clinical performance of cranial computed tomography rules in patients with minor head injury: a multicenter prospective study. Academic Emergency Medicine. 2011;18(6):597-604.

Reuter-Rice K. Transcranial Doppler ultrasound use in pediatric traumatic brain injury. Journal of radiology nursing. 2017;36(1):3-9.

Physicians ACoE. Policy Statement. Ultrasound Guidelines: Emergency. Point-of-care, and Clinical Ultrasound Guidelines in Medicine. 2016.

Weinberg ER, Tunik MG, Tsung JW. Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury. 2010;41(8):862-8.

Parri N, Crosby BJ, Glass C, Mannelli F, Sforzi I, Schiavone R, et al. Ability of emergency ultrasonography to detect pediatric skull fractures: a prospective, observational study. The Journal of emergency medicine. 2013;44(1):135-41.

Riera A, Chen L. Ultrasound evaluation of skull fractures in children: a feasibility study. Pediatric emergency care. 2012;28(5):420-5.

Dunning J, Batchelor J, Stratford-Smith P, Teece S, Browne J, Sharpin C, et al. A meta-analysis of variables that predict significant intracranial injury in minor head trauma. Archives of disease in childhood. 2004;89(7):653-9.

Huisman TA. Intracranial hemorrhage: ultrasound, CT and MRI findings. European radiology. 2005;15(3):434-40.

Aaslid R, Markwalder T-M, Nornes H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. Journal of neurosurgery. 1982;57(6):769-74.

Boran P, Oğuz F, Furman A, Sakarya S. Evaluation of fontanel size variation and closure time in children followed up from birth to 24 months. Journal of Neurosurgery: Pediatrics. 2018;22(3):323-9.

Hill MA. Embryology Musculoskeletal System - Skull Development 2019, September 17 [cited 2019 08-Jun-2019]. Available from: https://embryology.med.unsw.edu.au/embryology/index.php/Musculoskeletal_System_-_Skull_Development.

Jha RT, Magge SN, Keating RF. Diagnosis and Surgical Options for Craniosynostosis. Principles of Neurological Surgery: Elsevier; 2018. p. 148-69. e7.

Chamnanvanakij S, Rollins N, Perlman JM. Subdural hematoma in term infants. Pediatric neurology. 2002;26(4):301-4.

Barr RM. Craniofacial Trauma. In: Brant WE, Helms CA, editors. Fundamentals of diagnostic radiology. 4th ed: Lippincott Williams & Wilkins; 2012. p. 51.

Papa L, GoldbergWalls SA. Head trauma. In: Walls R, Hockberger R, Gausche-Hill M, editors. Rosen's emergency medicine-concepts and clinical practice. 9th ed: Elsevier Health Sciences; 2017. p. 301.

Rabiner JE, Friedman LM, Khine H, Avner JR, Tsung JW. Accuracy of point-of-care ultrasound for diagnosis of skull fractures in children. Pediatrics. 2013;131(6):e1757-e64.

Steiner S, Riebel T, Nazarenko O, Bassir C, Steger W, Vogl T, et al. Skull injury in childhood: comparison of ultrasonography with conventional X-rays and computerized tomography. RoFo: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin. 1996;165(4):353-8.

McCormick T, Chilstrom M, Childs J, McGarry R, Seif D, Mailhot T, et al. Point-of-care ultrasound for the detection of traumatic intracranial hemorrhage in infants: a pilot study. Pediatric emergency care. 2017;33(1):18-20.

Gallagher RA, Levy JA. Advances in point-of-care ultrasound in pediatric emergency medicine. Current opinion in pediatrics. 2014;26(3):265-71.

Marin JR, Abo AM, Arroyo AC, Doniger SJ, Fischer JW, Rempell R, et al. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Critical ultrasound journal. 2016;8(1):16.


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