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Performance of computed tomography of the head to evaluate for skull fractures in infants with suspected non-accidental trauma

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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.

Materials and 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.

Conclusion

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.

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Authors and Affiliations

  1. Section of Public Health Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin St., Suite A2275, Houston, TX, 77030, USA

    Paige A. Culotta, Quynh-Anh Tran & Marcella Donaruma-Kwoh

  2. The Edward B. Singleton, MD, Department of Pediatric Radiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    James E. Crowe, Jeremy Y. Jones, Amy R. Mehollin-Ray, H. Brandon Tran & Cristina T. Dodge

  3. Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Elizabeth A. Camp & Andrea T. Cruz

  4. Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Andrea T. Cruz

Authors
  1. Paige A. Culotta
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  2. James E. Crowe
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  3. Quynh-Anh Tran
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  4. Jeremy Y. Jones
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  5. Amy R. Mehollin-Ray
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  7. Marcella Donaruma-Kwoh
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  8. Cristina T. Dodge
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  9. Elizabeth A. Camp
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  10. Andrea T. Cruz
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Correspondence to Paige A. Culotta.

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Culotta, P.A., Crowe, J.E., Tran, QA. et al. Performance of computed tomography of the head to evaluate for skull fractures in infants with suspected non-accidental trauma. Pediatr Radiol 47, 74–81 (2017). https://doi.org/10.1007/s00247-016-3707-7

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  • DOI: https://doi.org/10.1007/s00247-016-3707-7

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