Ultrasound in Detection of Skull Fractures in Children Younger Than Two Years Old with Closed Head Injuries

Paediatrics head injuries is a frequent cause of emergency department (ER) visits. The incidence of head traumas in children varies from one country to other with an estimated 47 to 280 per 100,000 children presented to the ER each year due to traumatic brain injury worldwide. Head computed tomography (CT) is the most frequent CT scan performed in paediatrics population, majority of those scans are done to evaluate trauma. Head CT scans increase the risk of developing brain malignancies and leukemia in exposed pediatric patients. Many efforts have been made to limit the use of CT in children with head injuries.

Our aim was to evaluate the role of skull ultrasound in detection of skull fractures children younger than two years old with closed head injuries.

Type of study was a prospective observational study, sampling method was convenient sampling. The study was conducted according to the stipulations of the Ain Shams University (ASU) ethical and scientific committee. The privacy of participants and confidentiality of data was guaranteed during the various phases of the study. The study was conducted at the radiology unit, Emergency Department, ASU Hospital. The main source of data for this study was patients referred to the Emergency department. Children younger than 2 years presenting with closed head injuries and referred to the radiology department, ASU hospital to perform CT brain, Study Period: 6 months, onset in March 2020.

We found that skull ultrasound examination of pediatric patients with closed head injuries and Glasgow coma scale (GCS) of 14-15 have a high sensitivity and specificity in detecting skull fractures and subsequently prediction of an underlying traumatic brain injury (TBI) in these patients. Ultrasonographic assessment of the whole cranial vault is not always feasible as most of these age group patients are excessively crying and irritable at presentation, applying the ultrasound probe makes them more irritable and are difficult to maintain their head position during the scan. Although head CT is the gold standard diagnostic modality in the setting of head trauma, it exposes patients to significant ionizing radiation, ultrasonography is a safe diagnostic modality and doesn’t expose the patient to ionizing radiation.

Skull ultrasound in the setting of pediatrics mild closed head injuries is feasible, safe, sensitive and specific. It can play a complementary rule in risk stratification of these patients.