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

Abstract

aediatrics head injuries is a frequent cause of emergency department visits. Head CT is the most frequent CT scan performed in paediatrics population, it is associated with increased 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. We found that skull ultrasound examination of pediatric patients with mild closed head injuries is feasible, safe, sensitive and specific. Ultrasonographic assessment of the whole cranial vault was not always feasible as most of these age group patients are excessively crying and irritable. 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. It can play a complementary rule with the PECARN clinical prediction rules for risk stratification of these patients. US can prevent additional ionizing radiation exposure if the initial image acquisition was degraded by motion artifact and there is a specific region of concern that requires reevaluation for presence of fractures. It can also decrease hospital stay in patients who are classified as an intermediate risk patients and do not require CT scanning according to the emergency