Written by Clay Smith
Head ultrasound (HUS) via open fontanelle was a poor screening tool for intracranial bleed due to accidental or inflicted trauma.
Why does this matter?
Radiation exposure is associated with development of later malignancy in children, and the earlier the exposure, the greater the risk. Would HUS through an open fontanelle work to rule out intracranial bleed instead?
You have to use other imaging
This study included 283 children, median age 33 days, getting a HUS to rule out intracranial hemorrhage but not, "for reasons related to prematurity, transplant or oncologic evaluations, routine follow-up or preoperative screen, or congenital and known perinatal anomalies." They found that compared to the gold standard of either CT, MRI, or clinical outcome, the sensitivity for HUS was 67%, specificity 99%. This means HUS is not a good screening tool in patients being evaluated for intracranial bleed related to accidental or inflicted trauma. Most of the injuries missed were not trivial bleeds. The specificity was great. So if a bleed is seen, it is unlikely to be a false positive. HUS could also be used in patients who are too unstable to leave the department for CT or MRI.
The Utility of Cranial Ultrasound for Detection of Intracranial Hemorrhage in Infants. Pediatr Emerg Care. 2018 Feb;34(2):96-101. doi: 10.1097/PEC.0000000000000696.
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