title: Performance of computed tomography of the head to evaluate for skull fractures in infants with suspected non-accidental trauma.
abstract: BACKGROUND
  Young children with suspected abusive head trauma often receive skull radiographs to evaluate for fractures as well as computed tomography (CT) of the head to assess for intracranial injury. Using a CT as the primary modality to evaluate both fracture and intracranial injury could reduce exposure to radiation without sacrificing performance.
  
  
  OBJECTIVE
  To evaluate the sensitivity of CT head with (3-D) reconstruction compared to skull radiographs to identify skull fractures in children with suspected abusive head trauma.
  
  
  METHODS
  This was a retrospective (2013-2014) cross-sectional study of infants evaluated for abusive head trauma via both skull radiographs and CT with 3-D reconstruction. The reference standard was skull radiography. All studies were read by pediatric radiologists and neuroradiologists, with ten percent read by a second radiologist to evaluate for interobserver reliability.
  
  
  RESULTS
  One hundred seventy-seven children (47% female; mean/median age: 5 months) were included. Sixty-two (35%) had skull fractures by radiography. CT with 3-D reconstruction was 97% sensitive (95% confidence interval [CI]: 89-100%) and 94% specific (CI: 87-97%) for skull fracture. There was no significant difference between plain radiographs and 3-D CT scan results (P-value = 0.18). Kappa was 1 (P-value <0.001) between radiologist readings of CTs and 0.77 (P = 0.001) for skull radiographs.
  
  
  CONCLUSIONS
  CT with 3-D reconstruction is equivalent to skull radiographs in identifying skull fractures. When a head CT is indicated, skull radiographs add little diagnostic value.
authors.affiliation: Section of Public Health Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St., Suite A2275, Houston, TX, 77030, USA. paculott@texaschildrens.org.
authors.forename: Paige A
authors.initials: PA
authors.lastname: Culotta
authors.affiliation: The Edward B. Singleton, MD, Department of Pediatric Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Crowe
authors.affiliation: Section of Public Health Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St., Suite A2275, Houston, TX, 77030, USA.
authors.forename: Quynh-Anh
authors.initials: QA
authors.lastname: Tran
authors.affiliation: The Edward B. Singleton, MD, Department of Pediatric Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Jeremy Y
authors.initials: JY
authors.lastname: Jones
authors.affiliation: The Edward B. Singleton, MD, Department of Pediatric Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Mehollin-Ray
authors.affiliation: The Edward B. Singleton, MD, Department of Pediatric Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: H Brandon
authors.initials: HB
authors.lastname: Tran
authors.affiliation: Section of Public Health Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St., Suite A2275, Houston, TX, 77030, USA.
authors.forename: Marcella
authors.initials: M
authors.lastname: Donaruma-Kwoh
authors.affiliation: The Edward B. Singleton, MD, Department of Pediatric Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Cristina T
authors.initials: CT
authors.lastname: Dodge
authors.affiliation: Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Camp
authors.affiliation: Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.|Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Andrea T
authors.initials: AT
authors.lastname: Cruz
mesh_terms: D002649:Child Abuse; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008297:Male; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012887:Skull Fractures / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Computed tomography; Fracture; Infant; Non-accidental trauma; Radiography; Sensitivity