Research Article
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Bedside Ultrasonographic Evaluation of Skull Fractures in Pediatric Head Trauma Patients Admitted to Emergency Department

Year 2019, Volume: 5 Issue: 3, 233 - 238, 31.12.2019

Emre Gökçen Atakan Savrun

https://doi.org/10.19127/mbsjohs.647426
Cited By: 1

Abstract

Objective:
Among children with minor head trauma, the incidence of skull fractures is
increased especially in those under one year of age. Several studies
investigated the association between skull fracture and traumatic brain injury.
In the present study, we aimed to test the potential of ultrasonography in
detecting linear skull fracture in pediatric patients with minor head trauma.



Methods:
Patients under the age of 18
years with minor head trauma who presented to the emergency units of Bozok
University Faculty of Medicine or Ordu University Training and Research
Hospital between March 1, 2019 and November 1, 2019 and were planned to undergo
head CT by their responsible physicians were included in the present study. The
exclusion criteria were a Glasgow Coma Scale (GCS) score <14, traumatic open
skull deformity, depressed skull fracture, penetrating head trauma, and
hemodynamic instability.



Results:
A total of 62 patients (%64,5
males) with a mean age of 7.29 years were included. The sensitivity and
specificity of ultrasound in detection of fractures were %84.6 (% 95 CI: 65.13-
95.6) and % 94.4 (% 95 CI: 81.3-99.3), respectively.



Conclusion:
In conclusion, we suggest
that the use of ultrasound before CT examination in patients with minor head
trauma may be a helpful means to detect cranial fractures.

Keywords

Ultrasonographic Pediatric Head Trauma Patients Emergency Department

References

  • Arnholz D, Hymel KP, Hay TC, Jenny C. Bilateral pediatric skull fractures: accident or abuse? Journal of Trauma and Acute Care Surgery. 1998;45(1):172-4.
  • Atabaki SM. Pediatric head injury. Pediatrics in Review. 2007;28(6):215.
  • Blackwell CD, Gorelick M, Holmes JF, Bandyopadhyay S, Kuppermann N. Pediatric head trauma: changes in use of computed tomography in emergency departments in the United States over time. Annals of emergency medicine. 2007;49(3):320-4.
  • Boran BO, Boran P, Barut N, Akgun C, Celikoglu E, Bozbuga M. Evaluation of mild head injury in a pediatric population. Pediatric neurosurgery. 2006;42(4):203-7.
  • Brenner H, Gefeller O. Variation of sensitivity, specificity, likelihood ratios and predictive values with disease prevalence. Statistics in medicine. 1997;16(9):981-91.
  • Coskun F. Emergency Ultrasonography (PoCUS) in the Emergency Medicine Training Curriculum (PoCUS). Turkiye Klinikleri Emergency Medicine-Special Topics. 2018;4(1):106-12.
  • Er A, Akman C, Alataş I, Unlu HB, Ceylan I, Gün C, et al. Should Children with Minor Head Injury Routinely Have CT Scan? JOPP. 2013;5(3):131-5.
  • Feuerman T, Wackym PA, Gade GF, Becker DP. Value of skull radiography, head computed tomographic scanning, and admission for observation in cases of minor head injury. Neurosurgery. 1988;22(3):449-53.
  • Fundaro C, Caldarelli M, Monaco S, Cota F, Giorgio V, Filoni S, et al. Brain CT scan for pediatric minor accidental head injury. An Italian experience and review of literature. Child's Nervous System. 2012;28(7):1063-8.
  • Fundarò C, Caldarelli M, Monaco S, Cota F, Giorgio V, Filoni S, et al. Brain CT scan for pediatric minor accidental head injury. An Italian experience and review of literature. Child's Nervous System. 2012;28(7):1063-8.
  • Furuya Y, Edwards MS, Alpers CE, Tress BM, Ousterhout DK, Norman D. Computerized tomography of cranial sutures: Part 1: Comparison of suture anatomy in children and adults. Journal of neurosurgery. 1984;61(1):53-8.
  • Greenes DS, Schutzman SA. Clinical indicators of intracranial injury in head-injured infants. Pediatrics. 1999;104(4):861-7.
  • Greenes DS, Schutzman SA. Clinical significance of scalp abnormalities in asymptomatic head-injured infants. Pediatric emergency care. 2001;17(2):88-92.
  • Greenes DS, Schutzman SA. Infants with isolated skull fracture: what are their clinical characteristics, and do they require hospitalization? Annals of emergency medicine. 1997;30(3):253-9.
  • Klemetti S, Uhari M, Pokka T, Rantala H. Evaluation of decision rules for identifying serious consequences of traumatic head injuries in pediatric patients. Pediatric emergency care. 2009;25(12):811-5.
  • Mannix R, Meehan WP, Monuteaux MC, Bachur RG. Computed tomography for minor head injury: variation and trends in major United States pediatric emergency departments. The Journal of pediatrics. 2012;160(1):136-9. e1.
  • 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.
  • 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.
  • Riera A, Chen L. Ultrasound evaluation of skull fractures in children: a feasibility study. Pediatr Emerg Care. 2012;28(5):420-5.Sanborn PA, Michna E, Zurakowski D, Burrows PE, Fontaine PJ, Connor L, et al. Adverse cardiovascular and respiratory events during sedation of pediatric patients for imaging examinations. Radiology. 2005;237(1):288-94.
  • Schutzman SA, Greenes DS. Pediatric minor head trauma. Annals of emergency medicine. 2001;37(1):65-74.
  • Siaarti Lg. Siaarti-Sarnepi guidelines for the management of severe pediatric head injury. Minerva anestesiologica. 2004;70:549-604.
  • Stein SC, O'Malley KF, Ross SE. Is routine computed tomography scanning too expensive for mild head injury? Annals of emergency medicine. 1991;20(12):1286-9.
  • Stein SC, Ross SE. Mild head injury: a plea for routine early CT scanning. The Journal of trauma. 1992;33(1):11-3.
  • Thiruppathy S, Muthukumar N. Mild head injury: revisited. Acta neurochirurgica. 2004;146(10):1075-83.
  • Verma S, Lal N, Lodha R, Murmu L. Childhood trauma profile at a tertiary care hospital in India. Indian pediatrics. 2009;46(2).
  • 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.
  • Yanagawa Y, Sakamoto T. Characteristics of pediatric trauma in an urban city in Japan. Pediatric emergency care. 2009;25(9):572-4.

Year 2019, Volume: 5 Issue: 3, 233 - 238, 31.12.2019

Emre Gökçen Atakan Savrun

https://doi.org/10.19127/mbsjohs.647426
Cited By: 1

Abstract

References

  • Arnholz D, Hymel KP, Hay TC, Jenny C. Bilateral pediatric skull fractures: accident or abuse? Journal of Trauma and Acute Care Surgery. 1998;45(1):172-4.
  • Atabaki SM. Pediatric head injury. Pediatrics in Review. 2007;28(6):215.
  • Blackwell CD, Gorelick M, Holmes JF, Bandyopadhyay S, Kuppermann N. Pediatric head trauma: changes in use of computed tomography in emergency departments in the United States over time. Annals of emergency medicine. 2007;49(3):320-4.
  • Boran BO, Boran P, Barut N, Akgun C, Celikoglu E, Bozbuga M. Evaluation of mild head injury in a pediatric population. Pediatric neurosurgery. 2006;42(4):203-7.
  • Brenner H, Gefeller O. Variation of sensitivity, specificity, likelihood ratios and predictive values with disease prevalence. Statistics in medicine. 1997;16(9):981-91.
  • Coskun F. Emergency Ultrasonography (PoCUS) in the Emergency Medicine Training Curriculum (PoCUS). Turkiye Klinikleri Emergency Medicine-Special Topics. 2018;4(1):106-12.
  • Er A, Akman C, Alataş I, Unlu HB, Ceylan I, Gün C, et al. Should Children with Minor Head Injury Routinely Have CT Scan? JOPP. 2013;5(3):131-5.
  • Feuerman T, Wackym PA, Gade GF, Becker DP. Value of skull radiography, head computed tomographic scanning, and admission for observation in cases of minor head injury. Neurosurgery. 1988;22(3):449-53.
  • Fundaro C, Caldarelli M, Monaco S, Cota F, Giorgio V, Filoni S, et al. Brain CT scan for pediatric minor accidental head injury. An Italian experience and review of literature. Child's Nervous System. 2012;28(7):1063-8.
  • Fundarò C, Caldarelli M, Monaco S, Cota F, Giorgio V, Filoni S, et al. Brain CT scan for pediatric minor accidental head injury. An Italian experience and review of literature. Child's Nervous System. 2012;28(7):1063-8.
  • Furuya Y, Edwards MS, Alpers CE, Tress BM, Ousterhout DK, Norman D. Computerized tomography of cranial sutures: Part 1: Comparison of suture anatomy in children and adults. Journal of neurosurgery. 1984;61(1):53-8.
  • Greenes DS, Schutzman SA. Clinical indicators of intracranial injury in head-injured infants. Pediatrics. 1999;104(4):861-7.
  • Greenes DS, Schutzman SA. Clinical significance of scalp abnormalities in asymptomatic head-injured infants. Pediatric emergency care. 2001;17(2):88-92.
  • Greenes DS, Schutzman SA. Infants with isolated skull fracture: what are their clinical characteristics, and do they require hospitalization? Annals of emergency medicine. 1997;30(3):253-9.
  • Klemetti S, Uhari M, Pokka T, Rantala H. Evaluation of decision rules for identifying serious consequences of traumatic head injuries in pediatric patients. Pediatric emergency care. 2009;25(12):811-5.
  • Mannix R, Meehan WP, Monuteaux MC, Bachur RG. Computed tomography for minor head injury: variation and trends in major United States pediatric emergency departments. The Journal of pediatrics. 2012;160(1):136-9. e1.
  • 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.
  • 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.
  • Riera A, Chen L. Ultrasound evaluation of skull fractures in children: a feasibility study. Pediatr Emerg Care. 2012;28(5):420-5.Sanborn PA, Michna E, Zurakowski D, Burrows PE, Fontaine PJ, Connor L, et al. Adverse cardiovascular and respiratory events during sedation of pediatric patients for imaging examinations. Radiology. 2005;237(1):288-94.
  • Schutzman SA, Greenes DS. Pediatric minor head trauma. Annals of emergency medicine. 2001;37(1):65-74.
  • Siaarti Lg. Siaarti-Sarnepi guidelines for the management of severe pediatric head injury. Minerva anestesiologica. 2004;70:549-604.
  • Stein SC, O'Malley KF, Ross SE. Is routine computed tomography scanning too expensive for mild head injury? Annals of emergency medicine. 1991;20(12):1286-9.
  • Stein SC, Ross SE. Mild head injury: a plea for routine early CT scanning. The Journal of trauma. 1992;33(1):11-3.
  • Thiruppathy S, Muthukumar N. Mild head injury: revisited. Acta neurochirurgica. 2004;146(10):1075-83.
  • Verma S, Lal N, Lodha R, Murmu L. Childhood trauma profile at a tertiary care hospital in India. Indian pediatrics. 2009;46(2).
  • 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.
  • Yanagawa Y, Sakamoto T. Characteristics of pediatric trauma in an urban city in Japan. Pediatric emergency care. 2009;25(9):572-4.
There are 27 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research articles
Authors

Emre Gökçen

Atakan Savrun

Publication Date December 31, 2019
Published in Issue Year 2019 Volume: 5 Issue: 3

Cite

Vancouver Gökçen E, Savrun A. Bedside Ultrasonographic Evaluation of Skull Fractures in Pediatric Head Trauma Patients Admitted to Emergency Department. Mid Blac Sea J Health Sci. 2019;5(3):233-8.

Cited By

Skull and scalp ultrasound in children: a review
Diagnostic radiology and radiotherapy
https://doi.org/10.22328/2079-5343-2023-14-3-7-17
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