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An 11-month-old child is brought to the emergency department following a witnessed fall from a dining room chair. There was no loss of consciousness and only a single episode of vomiting immediately following the fall. Neurological examination is normal, however, there is a 5 cm bruised boggy swelling in the left parietal region and you suspect there may be a skull fracture. The child meets the criteria for neuroimaging with CT scanning according to NICE guidance.1 The parents express anxiety about radiation exposure (a young relative is currently being treated for leukaemia), in addition to concerns about the need for sedation. The parents ask you about possible alternatives to CT scanning, such as MRI or ultrasound, as they have heard these modalities to not involve exposure to ionising radiation.
You wonder if ultrasound scanning is as sensitive as CT in detecting skull fractures.
Structured clinical question
In children presenting with suspected skull fractures (patient) is the use of ultrasound (intervention) as sensitive as CT scanning (comparison /control) in detecting skull fractures (outcome)?
Search strategy and outcome
A Cochrane library search was performed using the term ‘ultrasound’. No limits were placed on the search. One hundred and seventeen articles were returned, none of which were relevant.
Medline library was searched using the Pubmed interface employing the search terms ((head OR skull) AND (fracture OR injury) AND ultrasound AND CT AND (infant or child*)). This gave …