title: Point-of-Care Ultrasound for the Detection of Traumatic Intracranial Hemorrhage in Infants: A Pilot Study.
abstract: OBJECTIVE
  Computed tomography is the criterion standard imaging modality to detect intracranial hemorrhage (ICH) in children and infants after closed head injury, but its use can be limited by patient instability, need for sedation, and risk of ionizing radiation exposure. Cranial ultrasound is used routinely to detect intraventricular hemorrhage in neonates. We sought to determine if point-of-care (POC) cranial ultrasound performed by emergency physicians can detect traumatic ICH in infants.
  
  
  METHODS
  Infants with ICH diagnosed by computed tomography were identified. For every infant with an ICH, 2 controls with symptoms and diagnoses unrelated to head trauma were identified. Point-of-care cranial ultrasound was performed by an emergency physician on all patients, and video clips were recorded. Two ultrasound fellowship-trained emergency physicians, blinded to the patients' diagnosis and clinical status, independently reviewed the ultrasound clips and determined the presence or absence of ICH.
  
  
  RESULTS
  Twelve patients were included in the study, 4 with ICH and 8 controls. Observer 1 identified ICH with 100% sensitivity (95% confidence interval [CI], 40%-100%) and 100% specificity (95% CI, 60%-100%). Observer 2 identified ICH with 50% sensitivity (95% CI, 9%-98%) and 87.5% specificity (95% CI, 47%-99%). Agreement between observers was 75%, κ = 0.4 (P = 0.079; 95% CI, 0-0.95).
  
  
  CONCLUSIONS
  Traumatic ICH can be identified with POC cranial ultrasound by ultrasound fellowship-trained emergency physicians. Although variations between observers and wide confidence intervals preclude drawing meaningful conclusions about sensitivity and specificity from this sample, these results support the need for further investigation into the role of POC cranial ultrasound.
authors: From the *Department of Emergency Medicine, Los Angeles County + University of Southern California, Los Angeles; †Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA; ‡Department of Emergency Medicine, Cornell University, New York, NY; and §Department of Emergency Medicine, Stanford University, Palo Alto, CA.
authors: Taylor
authors: T
authors: McCormick
authors: Mikaela
authors: M
authors: Chilstrom
authors: Jeannine
authors: J
authors: Childs
authors: Ryan
authors: R
authors: McGarry
authors: Dina
authors: D
authors: Seif
authors: Thomas
authors: T
authors: Mailhot
authors: Phillips
authors: P
authors: Perera
authors: Tarina
authors: T
authors: Kang
authors: Ilene
authors: I
authors: Claudius
mesh_terms: D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020198:Intracranial Hemorrhage, Traumatic / Q000000981:diagnostic imaging*; D008297:Male; D010865:Pilot Projects; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography / Q000379:methods*