{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:16:12Z","timestamp":1782346572221,"version":"3.54.5"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Head trauma is a common reason for evaluation in the emergency department. The evaluation for traumatic brain injury involves computed tomography, exposing children to ionizing radiation. Skull fractures are associated with intracranial bleed. Point-of-care ultrasound (POCUS) can diagnose skull fractures.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objectives<\/jats:title>\n            <jats:p>We performed a systematic review\/meta-analysis to determine operating characteristics of POCUS skull studies in the diagnosis of fractures in pediatric head trauma patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We searched PubMed, EMBASE, and Web of Science for studies of emergency department pediatric head trauma patients. Quality Assessment Tool for Diagnostic Accuracy Studies 2 was used to evaluate risk of bias. Point-of-care ultrasound skull study operating characteristics were calculated and pooled using Meta-DiSc.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Six studies of 393 patients were selected with a weighted prevalence of 30.84%. Most studies were at low risk of bias. The pooled sensitivity (91%) and specificity (96%) resulted in pooled positive likelihood ratio (14.4) and negative likelihood ratio (0.14). Using the weighted prevalence of skull fractures across the studies as a pretest probability (31%), a positive skull ultrasound would increase the probability to 87%, whereas a negative test would decrease the probability of a skull fracture to 6%. To achieve a posttest probability of a skull fracture of ~2% would require a negative skull ultrasound in a patient with only a pretest probability of ~15%.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>A POCUS skull study significantly increases the probability of skull fracture, whereas a negative study markedly decreases the probability if the pretest probability is very low.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000001958","type":"journal-article","created":{"date-parts":[[2020,3,2]],"date-time":"2020-03-02T03:18:16Z","timestamp":1583119096000},"page":"e1701-e1707","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":15,"title":["The Utility of Ultrasound in Detecting Skull Fractures After Pediatric Blunt Head Trauma"],"prefix":"10.1097","volume":"37","author":[{"given":"Isaac","family":"Gordon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Sinert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Chao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,2,29]]},"reference":[{"key":"bib2-20250504","article-title":"Traumatic brain injury\u2013related emergency department visits, hospitalizations, and deaths\u2014United States, 2007 and 2013","volume":"66","year":"2017","journal-title":"MMWR Surveill Summ"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/S0140-6736(09)61558-0","article-title":"Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study","volume":"374","year":"2009","journal-title":"Lancet"},{"key":"bib4-20250504","doi-asserted-by":"crossref","first-page":"E1757","DOI":"10.1542\/peds.2012-3921","article-title":"Accuracy of point-of-care ultrasound for diagnosis of skull fractures in children","volume":"131","year":"2013","journal-title":"Pediatrics"},{"key":"bib5-20250504","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.injury.2010.04.020","article-title":"Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults","volume":"41","year":"2010","journal-title":"Injury"},{"key":"bib6-20250504","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1097\/PEC.0b013e318252da3b","article-title":"Ultrasound evaluation of skull fractures in children: a feasibility study","volume":"28","year":"2012","journal-title":"Pediatr Emerg Care"},{"key":"bib7-20250504","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jemermed.2012.02.038","article-title":"Ability of emergency ultrasonography to detect pediatric skull fractures: a prospective, observational study","volume":"44","year":"2013","journal-title":"J Emerg Med"},{"key":"bib8-20250504","article-title":"Accuracy of bedside ultrasound for the diagnosis of skull fractures in children aged 0 to 4 years","year":"2018","journal-title":"Pediatr Emerg Care"},{"key":"bib9-20250504","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.jpeds.2017.12.057","article-title":"Point-of-care ultrasound for the diagnosis of skull fractures in children younger than two years of age","volume":"196","year":"2018","journal-title":"J Pediatr"},{"key":"bib10-20250504","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1001\/jama.2017.19163","article-title":"Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: the PRISMA-DTA Statement","volume":"319","year":"2018","journal-title":"JAMA"},{"key":"bib11-20250504","article-title":"The utility of skull ultrasound in the diagnosis of fracture in pediatric patients with closed head injuries"},{"key":"bib12-20250504","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","article-title":"Meta-analysis of observational studies in epidemiology: a proposal for reporting. 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