From the Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey.
Pediatr Emerg Care. 2023 Feb 1;39(2):91-97. doi: 10.1097/PEC.0000000000002895. Epub 2023 Jan 9.
The aim of the present study was to determine the accuracy of point-of-care ultrasound (POCUS) for detecting skull fractures and to evaluate sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball vertical diameter (EVD) ratios in children with head trauma.
Children who presented with local signs of head trauma and underwent cranial computed tomography (CT) were enrolled. The suspected area was examined by POCUS to identify a skull fracture, and then the ONSD at 3 mm posterior to the globe and the EVD were measured. Ratios of ONSD measurement at 3 mm/EVD were reported. All ONSD measurements and ratios were calculated from cranial CT images.
There were 112 children enrolled in the study. The sensitivity and specificity of POCUS for skull fractures was 93.7% (95% confidence interval [CI], 82.8-98.6) and 96.8% (95% CI, 89.1-99.6), whereas the positive predictive value was 95.7% (95% CI, 85.1-98.8), and the negative predictive value was 95.3% (95% CI, 87.3-98.4). There was high agreement between POCUS and CT for identifying skull fractures (κ, 0.90 [±0.04]). In the group without elevated intracranial pressure findings on CT, patients with space-occupying lesions (SOLs) had higher sonographic ONSD measurements and ratios (P < 0.001) compared with cases without SOLs.
When used with clinical decision rules to minimize the risk for clinically important traumatic brain injury, POCUS seems to be a promising tool to detect skull fractures and calculate ONSD measurements and rates to predict the risk for SOLs and perform further risk stratification of children with minor head trauma.
本研究旨在确定即时超声（POCUS）检测颅骨骨折的准确性，并评估外伤性颅脑损伤患儿视神经鞘直径（ONSD）及其与眼球垂直直径（EVD）比值的超声测量值。
本研究纳入了因局部头部外伤而行头颅 CT 检查的患儿。使用 POCUS 检查疑似区域以确定颅骨骨折，并测量眼球后 3mm 处的 ONSD 和 EVD。报告 ONSD 测量值在 3mm 处与 EVD 的比值。所有 ONSD 测量值和比值均根据头颅 CT 图像计算得出。
本研究共纳入 112 例患儿。POCUS 检测颅骨骨折的灵敏度和特异度分别为 93.7%（95%可信区间 [CI]，82.8-98.6）和 96.8%（95% CI，89.1-99.6），阳性预测值为 95.7%（95% CI，85.1-98.8），阴性预测值为 95.3%（95% CI，87.3-98.4）。POCUS 与 CT 识别颅骨骨折的一致性较高（κ 值，0.90[±0.04]）。在 CT 未发现颅内压升高的患儿中，伴有占位性病变（SOL）的患儿的 ONSD 超声测量值及其比值更高（P<0.001），而无 SOL 的患儿则更低。
在与临床决策规则联合使用以最小化具有临床意义的外伤性脑损伤风险时，POCUS 似乎是一种很有前途的工具，可用于检测颅骨骨折并计算 ONSD 测量值和比率，以预测 SOL 风险，并对轻微头部外伤患儿进行进一步的危险分层。
