Choi Jea Yeon, Lim Yong Su, Jang Jae Ho, Park Won Bin, Hyun Soung Youl, Cho Jin Seong
From the Department of Emergency Medicine and Pediatric Emergency Medicine, Gachon University Gil Medical Center, Incheon, South Korea.
Pediatr Emerg Care. 2020 May;36(5):e268-e273. doi: 10.1097/PEC.0000000000001485.
The aim of this study was to investigate the accuracy of bedside ultrasound (US) performed by emergency physicians for diagnosing skull fractures in children 0 to 4 years old compared with the accuracy of head computed tomography (CT). We also sought to investigate characteristics and precautions associated with US.
This single-center prospective study involved children 0 to 4 years old who had a history of head trauma. Bedside US was performed by emergency medicine physicians, and the results were compared with CT scan interpretations provided by attending radiologists. The accuracy of US for the diagnosis of skull fractures was calculated, and the errors were reviewed.
A total of 87 patients were enrolled. Skull fracture was present in 13 patients (14.9%), according to CT. Bedside US had a sensitivity and specificity of 76.9% (95% confidence interval [CI], 46.0%-93.8%) and 100% (95% CI, 93.9%-100%), respectively. Overall positive predictive value was 100% (95% CI, 65.5%-100%), and negative predictive value was 96.1% (95% CI, 88.3%-99.0%). Three false-negative cases were observed.
Bedside US performed by emergency medicine physicians with short focused US training is a useful tool for diagnosing skull fractures in children 0 to 4 years of age. However, there were 3 false-negative cases. A meticulous examination is needed in the area adjacent to the orbital wall and skull base.
本研究旨在探讨急诊医生进行的床旁超声（US）诊断0至4岁儿童颅骨骨折的准确性，并与头部计算机断层扫描（CT）的准确性进行比较。我们还试图研究与超声相关的特征和注意事项。
这项单中心前瞻性研究纳入了有头部外伤史的0至4岁儿童。由急诊医学医生进行床旁超声检查，并将结果与放射科主治医生提供的CT扫描解读结果进行比较。计算超声诊断颅骨骨折的准确性，并对错误结果进行审查。
共纳入87例患者。根据CT检查，13例（14.9%）存在颅骨骨折。床旁超声的敏感性和特异性分别为76.9%（95%置信区间[CI]，46.0%-93.8%）和100%（95%CI，93.9%-100%）。总体阳性预测值为100%（95%CI，65.5%-100%），阴性预测值为96.1%（95%CI，88.3%-99.0%）。观察到3例假阴性病例。
接受短期聚焦超声培训的急诊医学医生进行的床旁超声是诊断0至4岁儿童颅骨骨折的有用工具。然而，有3例假阴性病例。需要对眶壁和颅底附近区域进行细致检查。
