Department of Pediatric Emergency Medicine and Trauma Center, Meyer Children's Hospital, Firenze, Italy.
Emergency Department, Dixie Regional Medical Center, St. George, UT.
J Pediatr. 2018 May;196:230-236.e2. doi: 10.1016/j.jpeds.2017.12.057. Epub 2018 Feb 28.
To determine the accuracy of skull point-of-care ultrasound (POCUS) for identifying fractures in children younger than 2 years of age with signs of head trauma, and the ability of POCUS to identify the type and depth of fracture depression.
This was a multicenter, prospective, observational study of children younger than 2 years of age with nontrivial mechanisms of injury and signs of scalp/skull trauma. Patients were enrolled if they underwent computed tomography (CT). Patients underwent clinical evaluation, in addition to a cranial POCUS in the emergency department (ED). From the POCUS examinations, we documented whether fractures were present or absent, their location, characteristics, and depth. POCUS and CT findings were compared to calculate the diagnostic accuracy.
We enrolled a convenience sample of 115 of 151 (76.1%) eligible patients. Of the 115 enrolled, 88 (76.5%) had skull fractures. POCUS had a sensitivity of 80 of 88 (90.9%; 95% CI 82.9-96.0) and a specificity of 23 of 27 (85.2%; 95% CI 66.3-95.8) for identifying skull fractures. Agreement between POCUS and CT to identify the type of fracture as linear, depressed, or complex was 84.4% (97 of 115) with a kappa of 0.75 (95% CI 0.70-0.84).
POCUS performed by emergency physicians may identify the type and depth of fractures in infants with local physical signs of head trauma with substantial accuracy. Emergency physicians should consider POCUS as an adjunct to clinical evaluation and prediction rules for traumatic brain injuries in children younger than 2 years of age.
确定针对有头部创伤体征且年龄小于 2 岁的儿童，应用即时床旁超声（POCUS）诊断骨折的准确性，以及 POCUS 识别骨折凹陷类型和深度的能力。
这是一项多中心、前瞻性、观察性研究，纳入年龄小于 2 岁且存在非特异性创伤机制和头皮/颅骨创伤体征的儿童。如果患者接受了计算机断层扫描（CT），则将其纳入研究。患者除在急诊科接受临床评估外，还接受了颅部 POCUS 检查。我们从 POCUS 检查中记录骨折的存在与否、位置、特征和深度。将 POCUS 和 CT 检查结果进行比较，以计算诊断准确性。
我们纳入了 151 例符合条件患者中的 115 例（76.1%）。在纳入的 115 例患者中，88 例（76.5%）存在颅骨骨折。POCUS 诊断颅骨骨折的敏感性为 80/88（90.9%；95%CI82.9-96.0），特异性为 23/27（85.2%；95%CI66.3-95.8）。POCUS 和 CT 用于识别线性、凹陷性或复杂性骨折类型的一致性为 84.4%（115 例中有 97 例），kappa 值为 0.75（95%CI0.70-0.84）。
急诊医生实施的 POCUS 可相当准确地识别存在局部头部创伤体征的婴儿的骨折类型和深度。急诊医生应考虑将 POCUS 作为 2 岁以下儿童创伤性脑损伤的临床评估和预测规则的辅助手段。
