Minor head trauma in infants - how accurate is cranial ultrasound performed by trained radiologists?

Peter, Claudia; Stranzinger, Enno; Heverhagen, Johannes T; Keitel, Kristina; Romano, Fabrizio; Busch, Jasmin D.; Slavova, Nedelina (2023). Minor head trauma in infants - how accurate is cranial ultrasound performed by trained radiologists? European journal of pediatrics, 182(7), pp. 3113-3120. Springer-Verlag 10.1007/s00431-023-04939-9

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Correct management of infants after minor head trauma is crucial to minimize the risk to miss clinically important traumatic brain injury (ciTBI). Current practices typically involve CT or in-hospital surveillance. Cranial ultrasound (CUS) provides a radiation-free and fast alternative. This study examines the accuracy of radiologist-performed CUS to detect skull fracture (SF) and/or intracranial hemorrhage (ICH). An inconspicuous CUS followed by an uneventful clinical course would allow exclusion of ciTBI with a great certainty. This monocentric, retrospective, observational study analyzed CUS in infants (< 12 months) after minor head trauma at Bern University Children's Hospital, between 7/2013 and 8/2020. The primary outcome was the sensitivity and specificity of CUS in detecting SF and/or ICH by comparison to the clinical course and to additional neuroimaging. Out of a total of 325 patients, 73% (n = 241) had a normal CUS, 17% (n = 54) were found with SF, and ICH was diagnosed in 2.2% patients (n = 7). Two patients needed neurosurgery and three patients deteriorated clinically during surveillance. Additional imaging was performed in 35 patients. The sensitivity of CUS was 93% ([0.83, 0.97] 95% CI) and the specificity 98% ([0.95, 0.99] 95% CI). All false-negative cases originated in missed SF without clinical deterioration; no ICH was missed.  Conclusion: This study shows high accuracy of CUS in exclusion of SF and ICH, which can cause ciTBI. Therefore, CUS offers a reliable method of neuroimaging in infants after minor head trauma and gives reassurance to reduce the duration of in-hospital surveillance. What is Known: • Minor head trauma can cause clinically important traumatic brain injury in infants, and the management of these cases is a challenge for the treating physician. • Cranial ultrasound (CUS) is regularly used in neonatology, but its accuracy after head trauma in infants is controversial. What is New: • CUS performed by a trained radiologist can exclude findings related to clinically important traumatic brain injury (ciTBI) with high sensitivity and specificity. It therefore offers reassurance in the management of infants after minor head trauma.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine > Notfallzentrum für Kinder und Jugendliche

UniBE Contributor:

Stranzinger, Enno, Heverhagen, Johannes, Keitel, Kristina, Romano, Fabrizio, Busch, Jasmin D., Slavova, Nedelina Bozhidarova

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0340-6199

Publisher:

Springer-Verlag

Language:

English

Submitter:

Pubmed Import

Date Deposited:

25 Apr 2023 10:46

Last Modified:

19 Jul 2023 00:13

Publisher DOI:

10.1007/s00431-023-04939-9

PubMed ID:

37093305

Uncontrolled Keywords:

Cranial ultrasound Head trauma Infants Intracranial hemorrhage Traumatic brain injury

BORIS DOI:

10.48350/181963

URI:

https://boris.unibe.ch/id/eprint/181963

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