title: Accuracy of point-of-care ultrasound for diagnosis of skull fractures in children.
abstract: OBJECTIVE
  To determine the test performance characteristics for point-of-care ultrasound performed by clinicians compared with computed tomography (CT) diagnosis of skull fractures.
  
  
  METHODS
  We conducted a prospective study in a convenience sample of patients ≤21 years of age who presented to the emergency department with head injuries or suspected skull fractures that required CT scan evaluation. After a 1-hour, focused ultrasound training session, clinicians performed ultrasound examinations to evaluate patients for skull fractures. CT scan interpretations by attending radiologists were the reference standard for this study. Point-of-care ultrasound scans were reviewed by an experienced sonologist to evaluate interobserver agreement.
  
  
  RESULTS
  Point-of-care ultrasound was performed by 17 clinicians in 69 subjects with suspected skull fractures. The patients' mean age was 6.4 years (SD: 6.2 years), and 65% of patients were male. The prevalence of fracture was 12% (n = 8). Point-of-care ultrasound for skull fracture had a sensitivity of 88% (95% confidence interval [CI]: 53%-98%), a specificity of 97% (95% CI: 89%-99%), a positive likelihood ratio of 27 (95% CI: 7-107), and a negative likelihood ratio of 0.13 (95% CI: 0.02-0.81). The only false-negative ultrasound scan was due to a skull fracture not directly under a scalp hematoma, but rather adjacent to it. The κ for interobserver agreement was 0.86 (95% CI: 0.67-1.0).
  
  
  CONCLUSIONS
  Clinicians with focused ultrasound training were able to diagnose skull fractures in children with high specificity.
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY 10467, USA. jrabiner@montefiore.org
authors.forename: Joni E
authors.initials: JE
authors.lastname: Rabiner
authors.forename: Lana M
authors.initials: LM
authors.lastname: Friedman
authors.forename: Hnin
authors.initials: H
authors.lastname: Khine
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Avner
authors.forename: James W
authors.initials: JW
authors.lastname: Tsung
mesh_terms: D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012887:Skull Fractures / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
keywords: emergency medicine; head trauma; pediatrics; skull fracture; ultrasound