Physical Examination Sensitivity for Skull Fracture in Pediatric Patients With Blunt Head Trauma: A Secondary Analysis of the National Emergency X-Radiography Utilization Study II Head Computed Tomography Validation Study - 20/02/23
, Malkeet Gupta, MD b, c, Robert M. Rodriguez, MD d, Gregory W. Hendey, MD b, Jake L. Wilson, MD b, c, Alexandra K. Quinones, BA c, William R. Mower, MD, PhD bAbstract |
Study objective |
We evaluated the emergency department (ED) providers’ ability to detect skull fractures in pediatric patients presenting with blunt head trauma.
Methods |
This was a secondary analysis of the National Emergency X-Radiography Utilization Study (NEXUS) Head computed tomography (CT) validation study. Demographics and clinical characteristics were analyzed for pediatric patients. Radiologist interpretations of head CT imaging were abstracted and cataloged. Detection of skull fractures was evaluated through provider response to specific clinical decision instrument criteria (NEXUS or Canadian head CT rules) at the time of initial patient evaluation. The presence of skull fracture was determined by formal radiologist interpretation of CT imaging.
Results |
Between April 2006, and December 2015, 1,018 pediatric patients were enrolled. One hundred twenty-eight (12.5%) children had a notable injury reported on CT head. Skull fracture was present in most (66.4%) children with intracranial injuries. The sensitivity and specificity of provider physical examination to detect skull fractures was 18.5% (95% confidence interval 10.5% to 28.7%) and 96.6% (95.3% to 97.7%), respectively. The most common injuries associated with skull fractures were subarachnoid hemorrhage (27%) and subdural hematoma (22.3%).
Conclusion |
Skull fracture is common in children with intracranial injury after blunt head trauma. Despite this, providers were found to have poor sensitivity for skull fractures in this population, and these injuries may be missed on initial emergency department assessment.
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| Please see page 335 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Steven M. Green, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: WRM conceived the study and designed the trial. WRM and RMR obtained funding. MG, WRM, RMR, and GWH supervised the conduct of the trial and data collection, including quality control. TEA, JLW, AKQ, and WRM abstracted data, TEA and WRM, analyzed data and performed statistical analyses, drafted the manuscript, and all authors contributed to its revision. WRM takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This work was funded, in part, by the following grants: Agency for Health Care Research and Quality (www.ahrq.gov) HS09699, National Center for Injury Prevention and Control (injury) CE001589, UC Center for Health Quality and Innovation (health.universityofcalifornia.edu/innovation-center) HL120466. The funders had no role in study design, data collection and analysis, publication decisions, or manuscript preparation. |
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Vol 81 - N° 3
P. 334-342 - mars 2023 Retour au numéro
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