Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients

Kralik, Stephen F.; Finke, Whitney; Wu, Isaac C.; Hicks, Ralph A.; Ho, Chang Yueh

doi:10.1007/s00247-017-3872-3

Cited by 17 publications

(8 citation statements)

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“…In addition, the added comprehensive detail of reconstructed 3D skull images of pediatric head trauma is especially helpful in reducing interpretation errors by less experienced community/nonpediatric radiologists. Pediatric emergency physicians and pediatric child abuse/forensic specialists can also use the 3D skull images, to improve their diagnostic capabilities and more accurately assess the plausibility of fracture features with the reported mechanism of injury 15–17,32 …”

Section: Discussionmentioning

confidence: 99%

“…Pediatric emergency physicians and pediatric child abuse/forensic specialists can also use the 3D skull images, to improve their diagnostic capabilities and more accurately assess the plausibility of fracture features with the reported mechanism of injury. [15][16][17]32 Helical head CTwith 3D reconstruction is also recognized as superior for diagnosing fractures in specific areas, such as the base of the skull and the occiput, the latter of which can be complicated by the variability of the lambdoid cranial suture lines. [33][34][35] Previous study confirms that the posteriorly based lambdoid sutures are the most common sutures to be involved with abusive skull fracture, possibly related to shaken impact syndrome with the posterior skull as the more likely primary point of contact after abusive shaking and subsequent subdural hematoma formation.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have already outlined the importance and value that head computed tomography (CT), especially helical imaging with 3-dimensional (3D) reconstruction images, can offer when evaluating skull fractures. 9,[15][16][17][18][19] However, this previous scope was primarily limited to identification of abusive skull fracture lines with attention to improved visualization of abusive characteristics, such as fracture diastasis and depression rather than cranial suture conspicuity.…”

mentioning

confidence: 99%

“…Skull radiography alone, especially of the uncooperative or critically ill child, can result in suboptimal visualization often with significant image rotation, resulting in limited evaluation of the cranial suture relationship to skull fractures. Previous studies have already outlined the importance and value that head computed tomography (CT), especially helical imaging with 3-dimensional (3D) reconstruction images, can offer when evaluating skull fractures 9,15–19 . However, this previous scope was primarily limited to identification of abusive skull fracture lines with attention to improved visualization of abusive characteristics, such as fracture diastasis and depression rather than cranial suture conspicuity.…”

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Cranial Suture Evaluation in Pediatric Head Trauma

2021

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Objectives: Pediatric skull fracture association with the cranial sutures (crossing, widening, or contacting 2 or more cranial sutures) is suggestive of abusive injury. We studied the efficacy of head computed tomography (CT) versus skull radiographs in identifying pediatric skull fracture association with cranial sutures and reviewed head CT literature recommendations for pediatric head trauma.Methods: Retrospective review was performed of skull radiographs and head CT at a tertiary care, free-standing children's hospital (2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019). Statistical 2-proportion Z test determined efficacy of head CT versus skull radiographs in assessing cranial suture involvement with fractures.Results: Forty-seven children with 56 abusive skull fractures and 47 children with 54 accidental skull fractures were evaluated, ages 1 to 36 months. Of the 110 total skull fractures evaluated, 51 abusive and 41 accidental skull fractures had terminal ends contacting cranial sutures for a total of 92 (84%). Twelve abusive fractures (24%) crossed sutures; no accidental fractures crossed sutures (P < 0.01). Of the 12 abusive cases with skull fractures that crossed sutures, 7 were definitively identified only on CT (P < 0.01). Widened sutures were documented in 4 (8%) of the abusive cases with skull fracture; none in the accidental cases. All 4 of these cases were equally identified on both skull radiography and CT imaging. In 21 of 47 abusive versus 5 of 47 accidental cases, CT identified skull fractures lines that extended to cranial sutures that were not definitive on skull radiography (P = 0.00022).Conclusions: Cranial suture involvement with pediatric skull fractures is common. Head CT significantly aided in the identification of skull fractures contacting and crossing cranial sutures in abusive cases, supporting eliminating concurrent skull radiographs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Cranial Suture Evaluation in Pediatric Head Trauma

2021

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“…3). Они у новорожденных редко повреждают твердую мозговую оболочку, но КТ может выявить ассоциированные гематомы [43,55,[58][59][60].…”

Section: переломыunclassified

Computed tomography of traumatic brain injury in infants and young children (a literature review)

Zaitceva

Mamatkulov

Ахадов

2022

Medicinskaâ vizualizaciâ

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Цель исследования: проанализировать последние исследования, относящиеся к вопросам применения компьютерной томографии (КТ) при черепно-мозговой травме (ЧМТ) у детей раннего возраста.Результаты. ЧМТ -одна из частых причин смерти и инвалидности у детей. Детская ЧМТ связана с рядом характеристик, отличающих ее от взрослых. Это обусловлено возрастными анатомо-физиологические различиями, зависящими от физического состояния ребенка и трудностями с неврологической оценкой у детей. Дети раннего возраста проявляют специфические патологические реакции на ЧМТ с четкими сопутствующими неврологическими проявлениями. В этом обзоре представлена важная информация о текущих аспектах использования КТ при всех видах изолированной тупой ЧМТ у детей в возрасте от рождения до 3 лет с учетом особенностей, соответствующих возрасту в условиях неотложной помощи. Хотя механизмы ЧМТ у раннего возраста аналогичны взрослым, визуальные проявления травм головы у детей имеют свои особенности из-за развивающегося мозга и свода черепа. Основная роль радиологаопределить и охарактеризовать тип и степень тяжести травмы головы, чтобы помочь правильному ведению пациента. Исходя из информации, полученной при КТ, зная механизм ЧМТ у младенцев и детей раннего возраста, радиологи играют ключевую роль как в диагностике, так и в выборе эффективного лечения и улучшении результатов лечения и исходов.Заключение. КТ головы с многоплановыми и 3D-реконструкциями в настоящее время заменила рентгенографию черепа при подозрения на ЧМТ и стала важнейшим диагностическим методом у пациентов с ЧМТ в условиях неотложной помощи. Рентгенограммы не добавляют дополнительной диагностической информации и могут быть исключены из исследования в случае проведения КТ с 3D-реконструкцией.

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Non-accidental Trauma

Hanson¹

2022

Pediatric Surgery

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Radiologic head CT interpretation errors in pediatric abusive and non-abusive head trauma patients

Abstract: A high incidence of radiologic interpretation errors may occur in pediatric trauma patients at risk for abusive head trauma who are referred from a community hospital. This suggests value for second interpretations of head CTs at a tertiary pediatric hospital for this patient population.

Cited by 17 publications

References 27 publications

Cranial Suture Evaluation in Pediatric Head Trauma

Cranial Suture Evaluation in Pediatric Head Trauma

Computed tomography of traumatic brain injury in infants and young children (a literature review)

Non-accidental Trauma

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