COMPARISON OF COMPUTED TOMOGRAPHY AND POINT-OF-CARE ULTRASOUND'S ACCURACY IN IDENTIFYING SKULL FRACTURES IN PEDIATRIC MILD HEAD INJURIES

Abstract

Background & Aim: Head trauma, particularly in children, is a significant public health concern, requiring urgent diagnosis. CT scans are preferred for closed head injury diagnosis, but concerns over radiation dose, cost, and sedation may limit accessibility. POCUS, with its portability and lack of radiation, presents a potential alternative for pediatric skull fracture diagnosis. The study evaluates POCUS's diagnostic accuracy compared to CT scans, aiming to improve rapid, cost-effective, and minimally invasive emergency diagnosis.

Methods: A six-month cross-sectional study was conducted at Ziauddin Hospital's Department of Emergency, North Campus, Karachi, involving 78 children aged ≤14 with head trauma, Glasgow Coma Scale scores of 13-15, suspected CHI with possible skull fractures, and needed CT scans. Consecutive sampling was used, excluding patients requiring airway management, hemodynamic instability, neurological deterioration, open deformities, or uncooperative for POCUS. Physical scalp assessment was conducted, and POCUS performed when CT scans were indicated. Descriptive statistics, diagnostic values, and post-stratification analysis were performed.

Results: Of the total 78, nearly two-third was male. The mean age of the study sample was 5.97(SD±4.59) years. The age group less than 6 years had more the 50% of the study sample. Scalp hematoma was observed in 33(42.31%) and based on the clinical findings the most affected area of the skull was the frontal and left and right parietal areas. Among the mechanism of injury, fall had the highest frequency. POCUS had a sensitivity and specificity of 70.27% (53.02-84.13%) and 95.12 %( 83.47-99.40), respectively.  Positive and negative predictive values were 92.86% and 78.00%, with an accuracy of 83.33% in comparison with CT scan in the diagnosis of skull fracture.

Conclusion: The findings demonstrated that POCUS, carried out by the resident emergency medicine, has a high degree of diagnostic accuracy and may be used as a tool in the treatment of patients with CHI.