{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:15:01Z","timestamp":1787022901104,"version":"build-2736575974"},"reference-count":34,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>To determine the test performance characteristics for point-of-care ultrasound performed by clinicians compared with computed tomography (CT) diagnosis of skull fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We conducted a prospective study in a convenience sample of patients \u226421 years of age who presented to the emergency department with head injuries or suspected skull fractures that required CT scan evaluation. After a 1-hour, focused ultrasound training session, clinicians performed ultrasound examinations to evaluate patients for skull fractures. CT scan interpretations by attending radiologists were the reference standard for this study. Point-of-care ultrasound scans were reviewed by an experienced sonologist to evaluate interobserver agreement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Point-of-care ultrasound was performed by 17 clinicians in 69 subjects with suspected skull fractures. The patients\u2019 mean age was 6.4 years (SD: 6.2 years), and 65% of patients were male. The prevalence of fracture was 12% (n = 8). Point-of-care ultrasound for skull fracture had a sensitivity of 88% (95% confidence interval [CI]: 53%\u201398%), a specificity of 97% (95% CI: 89%\u201399%), a positive likelihood ratio of 27 (95% CI: 7\u2013107), and a negative likelihood ratio of 0.13 (95% CI: 0.02\u20130.81). The only false-negative ultrasound scan was due to a skull fracture not directly under a scalp hematoma, but rather adjacent to it. The \u03ba for interobserver agreement was 0.86 (95% CI: 0.67\u20131.0).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Clinicians with focused ultrasound training were able to diagnose skull fractures in children with high specificity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2012-3921","type":"journal-article","created":{"date-parts":[[2013,5,20]],"date-time":"2013-05-20T20:48:16Z","timestamp":1369082896000},"page":"e1757-e1764","source":"Crossref","is-referenced-by-count":88,"title":["Accuracy of Point-of-Care Ultrasound for Diagnosis of Skull Fractures in Children"],"prefix":"10.1542","volume":"131","author":[{"given":"Joni E.","family":"Rabiner","sequence":"first","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, Children\u2019s Hospital at Montefiore\/Albert Einstein College of Medicine, Bronx, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lana M.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Mount Sinai School of Medicine\/Mount Sinai Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hnin","family":"Khine","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, Children\u2019s Hospital at Montefiore\/Albert Einstein College of Medicine, Bronx, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey R.","family":"Avner","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, Children\u2019s Hospital at Montefiore\/Albert Einstein College of Medicine, Bronx, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James W.","family":"Tsung","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Mount Sinai School of Medicine\/Mount Sinai Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2013,6,1]]},"reference":[{"key":"2021120900384927400_B1","doi-asserted-by":"crossref","DOI":"10.15620\/cdc.5571","volume-title":"Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths, 2002-2006","author":"Faul","year":"2010"},{"issue":"5","key":"2021120900384927400_B2","doi-asserted-by":"crossref","DOI":"10.1542\/peds.99.5.e11","article-title":"Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographs indicated?","volume":"99","author":"Quayle","year":"1997","journal-title":"Pediatrics"},{"issue":"1","key":"2021120900384927400_B3","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1067\/mem.2001.109440","article-title":"Pediatric minor head trauma.","volume":"37","author":"Schutzman","year":"2001","journal-title":"Ann Emerg Med"},{"issue":"22","key":"2021120900384927400_B4","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.1056\/NEJMra072149","article-title":"Computed tomography\u2014an increasing source of radiation exposure.","volume":"357","author":"Brenner","year":"2007","journal-title":"N Engl J Med"},{"issue":"4","key":"2021120900384927400_B5","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1007\/s00247-002-0671-1","article-title":"Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative.","volume":"32","author":"Brenner","year":"2002","journal-title":"Pediatr Radiol"},{"issue":"1","key":"2021120900384927400_B6","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1148\/radiol.2521090661","article-title":"Radiation, CT, and children: the simple answer is . . . it\u2019s complicated.","volume":"252","author":"Frush","year":"2009","journal-title":"Radiology"},{"issue":"3","key":"2021120900384927400_B7","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1542\/peds.2007-1910","article-title":"Radiation risk to children from computed tomography.","volume":"120","author":"Brody","year":"2007","journal-title":"Pediatrics"},{"key":"2021120900384927400_B8","volume-title":"Emergency Ultrasound","author":"Ma","year":"2008","edition":"2nd ed."},{"key":"2021120900384927400_B9","doi-asserted-by":"crossref","first-page":"S126","DOI":"10.1097\/01.CCM.0000260623.38982.83","article-title":"History of emergency and critical care ultrasound: the evolution of a new imaging paradigm.","volume":"35","author":"Kendall","year":"2007","journal-title":"Crit Care Med"},{"issue":"8","key":"2021120900384927400_B10","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1056\/NEJMra0909487","article-title":"Point-of-care ultrasonography.","volume":"364","author":"Moore","year":"2011","journal-title":"N Engl J Med"},{"issue":"4","key":"2021120900384927400_B11","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.annemergmed.2008.12.013","article-title":"Emergency ultrasound guidelines.","volume":"53","author":"American College of Emergency Physicians","year":"2009","journal-title":"Ann Emerg Med"},{"issue":"11","key":"2021120900384927400_B12","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1097\/PEC.0b013e318235e965","article-title":"Bedside ultrasound in the diagnosis of pediatric clavicle fractures.","volume":"27","author":"Chien","year":"2011","journal-title":"Pediatr Emerg Care"},{"issue":"8","key":"2021120900384927400_B13","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1302\/0301-620X.82B8.0821170","article-title":"Ultrasound in the diagnosis of fractures in children.","volume":"82","author":"H\u00fcbner","year":"2000","journal-title":"J Bone Joint Surg Br"},{"issue":"4","key":"2021120900384927400_B14","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/PEC.0b013e31819e34f7","article-title":"The utility of bedside ultrasonography in identifying fractures and guiding fracture reduction in children.","volume":"25","author":"Patel","year":"2009","journal-title":"Pediatr Emerg Care"},{"issue":"8","key":"2021120900384927400_B15","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","author":"Weinberg","year":"2010","journal-title":"Injury"},{"issue":"1","key":"2021120900384927400_B16","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1136\/emj.17.1.22","article-title":"Ultrasound imaging of forearm fractures in children: a viable alternative?","volume":"17","author":"Williamson","year":"2000","journal-title":"J Accid Emerg Med"},{"issue":"3","key":"2021120900384927400_B17","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1055\/s-2008-1027329","article-title":"Ultrasound in diagnosis of fractures in children: unnecessary harassment or useful addition to X-ray?","volume":"29","author":"Moritz","year":"2008","journal-title":"Ultraschall Med"},{"issue":"1","key":"2021120900384927400_B18","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","author":"Parri","year":"2013","journal-title":"J Emerg Med"},{"issue":"5","key":"2021120900384927400_B19","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","author":"Riera","year":"2012","journal-title":"Pediatr Emerg Care"},{"issue":"4","key":"2021120900384927400_B20","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1055\/s-2007-1015768","article-title":"Skull injury in childhood: comparison of ultrasonography with conventional X-rays and computerized tomography [in German]","volume":"165","author":"Steiner","year":"1996","journal-title":"Rofo"},{"issue":"7379","key":"2021120900384927400_B21","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1136\/bmj.326.7379.41","article-title":"Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative.","volume":"326","author":"Bossuyt","year":"2003","journal-title":"BMJ"},{"issue":"1","key":"2021120900384927400_B22","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.annemergmed.2012.07.112","article-title":"Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children.","volume":"61","author":"Rabiner","year":"2013","journal-title":"Ann Emerg Med"},{"issue":"2","key":"2021120900384927400_B23","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1001\/jama.1990.03440020109043","article-title":"How many patients are necessary to assess test performance?","volume":"263","author":"Arkin","year":"1990","journal-title":"JAMA"},{"issue":"10","key":"2021120900384927400_B24","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1016\/S0196-0644(05)81254-5","article-title":"Pediatric head injuries: can clinical factors reliably predict an abnormality on computed tomography?","volume":"22","author":"Dietrich","year":"1993","journal-title":"Ann Emerg Med"},{"issue":"2","key":"2021120900384927400_B25","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1097\/00006565-200104000-00002","article-title":"Clinical significance of scalp abnormalities in asymptomatic head-injured infants.","volume":"17","author":"Greenes","year":"2001","journal-title":"Pediatr Emerg Care"},{"issue":"9696","key":"2021120900384927400_B26","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","author":"Kuppermann","year":"2009","journal-title":"Lancet"},{"issue":"4","key":"2021120900384927400_B27","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1067\/S0196-0644(03)00425-6","article-title":"A decision rule for identifying children at low risk for brain injuries after blunt head trauma.","volume":"42","author":"Palchak","year":"2003","journal-title":"Ann Emerg Med"},{"issue":"5","key":"2021120900384927400_B28","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1542\/peds.107.5.983","article-title":"Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines.","volume":"107","author":"Schutzman","year":"2001","journal-title":"Pediatrics"},{"key":"2021120900384927400_B29","unstructured":"World Health Organization. Essential diagnostic imaging. Available at: www.who.int\/eht\/en\/DiagnosticImaging.pdf. Accessed February 12, 2013"},{"issue":"12","key":"2021120900384927400_B30","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.7863\/jum.2008.27.12.1735","article-title":"Utility of portable ultrasound in a community in Ghana.","volume":"27","author":"Spencer","year":"2008","journal-title":"J Ultrasound Med"},{"key":"2021120900384927400_B31","doi-asserted-by":"crossref","first-page":"S275","DOI":"10.1097\/01.CCM.0000260677.29207.B4","article-title":"Ultrasound applications in mass casualties and extreme environments.","volume":"35","author":"Ma","year":"2007","journal-title":"Crit Care Med"},{"issue":"1","key":"2021120900384927400_B32","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/01.TA.0000145083.47032.78","article-title":"FAST at MACH 20: clinical ultrasound aboard the International Space Station.","volume":"58","author":"Sargsyan","year":"2005","journal-title":"J Trauma"},{"issue":"1","key":"2021120900384927400_B33","doi-asserted-by":"crossref","first-page":"84","DOI":"10.3348\/kjr.2010.11.1.84","article-title":"Ultrasound diagnosis of either an occult or missed fracture of an extremity in pediatric-aged children.","volume":"11","author":"Cho","year":"2010","journal-title":"Korean J Radiol"},{"issue":"6\u20137","key":"2021120900384927400_B34","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1007\/s004020050268","article-title":"Scope and limitations of ultrasonography in the documentation of fractures\u2014an experimental study.","volume":"117","author":"Grechenig","year":"1998","journal-title":"Arch Orthop Trauma Surg"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/131\/6\/e1757\/898468\/peds_2012-3921.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/131\/6\/e1757\/898468\/peds_2012-3921.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T01:47:47Z","timestamp":1639014467000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/131\/6\/e1757\/31078\/Accuracy-of-Point-of-Care-Ultrasound-for-Diagnosis"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,6,1]]},"references-count":34,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2013,6,1]]},"published-print":{"date-parts":[[2013,6,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2012-3921","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,6,1]]}}}