Determining whether the use of bedside ultrasound is as effective as computed tomography at identifying pediatric skull fractures in the emergency department.

摘要

Problem: Computed tomography (CT) scanning in pediatric patients has some risk, including potentially harmful radiation exposure to the patient scanned. Research suggests that children are considerably more sensitive to radiation than adults and that the use of computed tomography in pediatric patients may lead to the development of cancer in the future. Currently, CT scanning is the primary test utilized in emergency departments to detect pediatric skull fractures (as well as more serious head injuries) as it provides high quality images of the skull and brain. Bedside ultrasound may be a safer alternative for identifying pediatric skull fractures compared to CT scanning as it has few, if any, risks. Few studies have directly compared the accuracy of bedside ultrasound for the detection of pediatric skull fractures in the emergency department to the accuracy of CT scanning. Methods: A search for published articles was conducted using the Columbia University Medical Center and the Weill Cornell Medical College electronic libraries. Data from PubMed and from common health statistical engines, such as the National Cancer Institute and the Center for Disease Control, were included in the search which spanned the years 2000-2012. Results: The majority of the research reviewed in this paper demonstrated a strong correlation with the use of emergency bedside ultrasound to diagnose pediatric skull fractures. However, all of these studies were small, a critical point when evaluating the research. Also, there was no standard training level of the sonographer---which may have a significant impact on findings. The sonographers in the studies above ranged in training from completing an 8-hour instructional course to having several years of experience in performing sonography. Therefore, while not the most crucial factor in this paper, further research on the level of training or credentialing in order to obtain accurate findings on bedside ultrasound is necessary. Conclusions: The results indicate that emergency bedside ultrasound could be used as a primary diagnostic tool for identifying pediatric skull fractures; however, this topic requires additional research, including much larger sample sizes.