Can three-dimensional reformatted computed tomography scans be useful to avoid misdiagnoses of skull fractures in pediatric emergency cases?

Abstract

Objective: To investigate whether three-dimensional (3-D) reformatted cranial computed tomography (CT) scans may contribute to the avoidance of misdiagnosis of skull fractures in pediatric emergency cases. Materials and Methods:This cross-sectional medical chart review was carried out in the pediatric emergency department of a tertiary care center. Data were derived from pediatric age group patients having head trauma patients whose conventional CT images were obtained at initial admission. Demographic, clinical, and radiological data, the location of the fracture, and possible causes of misdiagnoses were recorded. Results:This study included 27 children (21 males and six females). The average age was 41.92±43.25 (range, 1 to 137) months. The most common etiology for admission to the hospital was fall from height (85.2%). The fractures were detected on the parietal (n=12, 44.4%), frontal (n=7, 25.9%), occipital (n=7, 25.9%) and temporal (n=1, 3.7%) bones. In 12 cases (44.4%), skull fracture could not be detected at their initial admission. Five of these 12 cases were consulted to the radiologist, and diagnosis could not be established even by the radiologist. In 15 pediatric head trauma patients (55.6%), the skull fracture was confirmed by the radiologist. In two cases with an initial failure of diagnosis, 3-D reconstruction allowed the identification of fractures. Conclusion:The findings obtained in this study suggest that 3-D reconstruction of CT scans may increase the accuracy of diagnosis for pediatric skull fractures.