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Linear skull fracture in the simple X-ray and 3 dimensional computed tomography. Linear skull fractures on the occipital bone (A and B) and parietal bone (C) show not in the simple X-ray but clearly in the 3 dimensional computed tomography.
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In the pediatric population the skull has not yet undergone ossification and it is assumed that the diagnostic rate of skull fractures by simple X-rays are lower than that of adults. It has been recently proposed that the diagnostic rates of skull fractures by 3-dimensional computer tomography (3D-CT) are higher than simple X-rays. The authors ther...
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Background Infection can occur after compound depressed skull fracture (DSF) if not timely treated. Objectives To assess the time effect from accident to surgical intervention on surgical site infection (SSI). Patients and Methods A retrospective cohort study was performed on 63 patients admitted to Shar Hospital from September 1, 2020, to May 13,...
Citations
... The fractures are precisely located and identified by CT scan. 7 It also helps in the detection of epidural, subdural, subarachnoid, intraparenchymal and intraventricular hemorrhages, brain contusions and cerebral edema etc. The location & size of the lesion and the secondary findings like sulcal effacement and midline shift can differentiate the severe brain injury from the minor one on CT. ...
Background: Head injury is a global health problem that can cause disability and may result in death. CT scan detects and precisely localizes the skull fractures, epidural/subdural/subarachnoid hemorrhages, brain contusions and cerebral edema etc. CT has proven to be a valuable tool in the early diagnosis and prompt management of head trauma patients. Methods: A descriptive cross-sectional study, including 380 patients, presented to the radiology department of Hayatabad medical complex witha history of head trauma for computed tomography examination, from October 2019 to October 2020. The nature of the brain and skull lesions was analyzed in our study and the frequency of various findings was recorded. Results: Among 380 patients, the majority were males (248) making the male to female ratio to be around 2:1. The most prevalent finding was skull fractures (23.4%) followed by cerebral contusions (17.1%). Among extra-axial brain hemorrhages, extradural hematoma (15.2%) was observed more than subdural hematoma (6.8%) while only 3.4% presented with subarachnoid hemorrhages which also included intraventricular hemorrhages. Practical Implication: As road traffic accidents are the most common cause of head injuries so road traffic safety measures ought to be strictly enforced. Most of the CT scan done during head injuries were normal so CT guidelines for ordering should be implemented to scale back extra patient irradiation, unnecessary waste of resources Conclusion: Our study concluded that younger populations and males are more prone to head injury and road traffic accident is the most common mode of head trauma. So, ensuring proper traffic rules along with educating the more prone population will significantly reduce the incidence of serious head injuries. Keywords: Head Injury, Computed Tomography (CT), Road Traffic Accidents (RTA), Skull Fractures, Epidural Hematoma.
... Despite the high number of skull radiographs performed in pediatric head trauma, interpreting them can be a diagnostic challenge [32,33]. The sensitivity of radiography for pediatric skull fractures is 74%-81% [32,34], which is similar to or slightly higher than our external test results from the radiologists without the model's assistance All emergency physicians and one radiology resident rated this case as "probable fracture" or "definite fracture" in the first session. ...
... Despite the high number of skull radiographs performed in pediatric head trauma, interpreting them can be a diagnostic challenge [32,33]. The sensitivity of radiography for pediatric skull fractures is 74%-81% [32,34], which is similar to or slightly higher than our external test results from the radiologists without the model's assistance All emergency physicians and one radiology resident rated this case as "probable fracture" or "definite fracture" in the first session. They all changed to "definitely normal" in the second session with the model's assistance. ...
Objective:
To develop and evaluate a deep learning-based artificial intelligence (AI) model for detecting skull fractures on plain radiographs in children.
Materials and methods:
This retrospective multi-center study consisted of a development dataset acquired from two hospitals (n = 149 and 264) and an external test set (n = 95) from a third hospital. Datasets included children with head trauma who underwent both skull radiography and cranial computed tomography (CT). The development dataset was split into training, tuning, and internal test sets in a ratio of 7:1:2. The reference standard for skull fracture was cranial CT. Two radiology residents, a pediatric radiologist, and two emergency physicians participated in a two-session observer study on an external test set with and without AI assistance. We obtained the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity along with their 95% confidence intervals (CIs).
Results:
The AI model showed an AUROC of 0.922 (95% CI, 0.842-0.969) in the internal test set and 0.870 (95% CI, 0.785-0.930) in the external test set. The model had a sensitivity of 81.1% (95% CI, 64.8%-92.0%) and specificity of 91.3% (95% CI, 79.2%-97.6%) for the internal test set and 78.9% (95% CI, 54.4%-93.9%) and 88.2% (95% CI, 78.7%-94.4%), respectively, for the external test set. With the model's assistance, significant AUROC improvement was observed in radiology residents (pooled results) and emergency physicians (pooled results) with the difference from reading without AI assistance of 0.094 (95% CI, 0.020-0.168; p = 0.012) and 0.069 (95% CI, 0.002-0.136; p = 0.043), respectively, but not in the pediatric radiologist with the difference of 0.008 (95% CI, -0.074-0.090; p = 0.850).
Conclusion:
A deep learning-based AI model improved the performance of inexperienced radiologists and emergency physicians in diagnosing pediatric skull fractures on plain radiographs.
... 84 CT has been shown to increase the detection of skull fractures in children, identifying 10-30% more skull fractures than radiographs. 49,84,[89][90][91] In these studies, diastatic fractures were significantly more likely to be seen by CT than radiographs, although the relative increase in detectability of linear fractures was more modest. 49,84,90 In some instances, radiographs identified fractures that CT missed; however, this was rare. ...
... 49,84,[89][90][91] In these studies, diastatic fractures were significantly more likely to be seen by CT than radiographs, although the relative increase in detectability of linear fractures was more modest. 49,84,90 In some instances, radiographs identified fractures that CT missed; however, this was rare. Most of these studies were significantly aided by the use of advanced processing techniques such as multiplanar image reconstruction and 3D reconstructed modelling of CT images. ...
Non‐accidental injuries remain a leading cause of preventable morbidity and mortality in young children. The accurate identification of the full spectrum of injuries in children presenting with suspected abuse is essential to ensure the appropriate protective intervention is taken. The identification of occult bone fractures in this cohort is important as it raises the level of concern about the mechanism of injury and maintaining the child's safety. Radiographic imaging remains the modality of choice for skeletal assessment; however, current studies report concerns regarding the ability of radiographs to detect certain fractures in the acute stage. As such, alternative modalities for the detection of fractures have been proposed. This article reviews the current literature regarding fracture detectability and radiation dose burden of imaging modalities currently used for the assessment of occult bony injury in young children in whom non‐accidental injury is suspected.
... High radiation dose has traditionally limited use of head CT for children, but the advent of low-dose helical scanning with iterative reconstruction has substantially alleviated that concern. Helical head CT, particularly when it includes 3D reconstruction of the skull, is widely used as an imaging aid for evaluation of pediatric skull fractures [13][14][15][16][17][18][19]. The American Academy of Pediatrics has adopted head CT as the standard of care of patients with suspected abusive head trauma given the high propensity for intracranial injury in the acute phase [20]. ...
OBJECTIVE. The Fontan procedure has significantly improved the survival in children with a functional single ventricle, but it is associated with chronically elevated systemic venous pressure that leads to multisystemic complications. Imaging plays an important role in assessing these complications and guiding management. The pathophysiology, imaging modalities, and current surveillance recommendations are discussed and illustrated. CONCLUSION. Significant improvement in survival of patients with Fontan circulation is associated with ongoing cardiac and extracardiac comorbidities and multisystemic complications. The liver and intestines are particularly vulnerable to damage. In addition, this patient population has been shown to be at increased risk of certain malignancies such as hepatocellular carcinoma and neuroendocrine tumors. Familiarity with imaging findings of Fontan-associated liver disease and other abdominal complications of the Fontan circulation is essential for radiologists because we are likely to encounter these patients in our general practice.
... Head injuries are extremely common in young children and infants, both as a result of accidents and abuse, and often result in skull fractures [1][2][3]. It is imperative that pediatric skull fractures be accurately detected in order to determine possible cause and manner of death [3][4][5][6][7][8]. In addition, it is important that all skull fractures are detected in order to identify potential victims of abuse, since failure to do so can put them at further risk of injury and allow perpetrators to go free [9]. ...
... In a study of 85 pediatric patients with skull fractures, CT scans were found to be more sensitive than X-rays in identifying linear, depressed, and diastatic skull fractures [4]. Culotta et al. [5], however, reported no significant difference in the sensitivities for CTs and X-rays when identifying skull fractures of 177 children. ...
... Skull fractures are common in children, both as a result of accidental and abusive trauma [1][2][3]. The accurate detection of these fractures is critical in order to determine possible cause and manner of death [3][4][5][6][7][8]. Furthermore, as is common during forensic anthropological examinations, assessing the location and pattern of each skull fracture has implications for determining the minimum number of blows inflicted, as well as potentially distinguishing between accidental and abusive trauma. ...
Skull fractures are common in children both due to abuse and accidental incidences. The accurate detection of these fractures may therefore be critical. The aim of this study was to investigate the reliability of CT, X‐ray, and Lodox® scans, the latter which has not previously been evaluated and is commonly employed in South Africa, in detecting the number, location and type of pediatric skull fractures. Blunt force trauma was inflicted with a mallet on ten piglet skulls, which were CT, X‐ray, and Lodox® scanned and then macerated. The number, location, and type of skull fractures visible using each imaging modality, and on the cleaned skulls, were recorded. Sensitivities and specificities of each method were calculated. For fracture number and location, CTs had a sensitivity of 47.3%, X‐rays 22.4% and Lodox® 23.3%. For fracture type, sensitivities were 46.1%, 16.6%, and 17.8% for CT, X‐ray, and Lodox®, respectively. Specificities were high (92.5%–100%) which reduces the risk of incorrectly diagnosing fractures. However, low sensitivities increase the risk of failing to identify fractures and possible victims of abuse. Osteological analysis should preferably be the method of choice when evaluating pediatric skull trauma, and CTs should be used when osteological analysis is not feasible. If CT scanners are not available, X‐rays and Lodox® may have to be used. In these cases, additional radiographic views of the skull are imperative and may increase the sensitivity of these methods, although they are not recommended to detect exact pediatric skull fracture number, location, and type.
... We limited our meta-analysis to children with an isolated skull fracture who had a head CT performed that did not identify an intracranial hemorrhage. However, skull fractures can also be diagnosed on clinical examination, radiograph, 40,41 or point-of-care ultrasonography. 42,43 Although these modalities can identify the presence of a skull fracture, they do so with lower sensitivity and specificity than CT. ...
Study objective:
Most studies of children with isolated skull fractures have been relatively small, and rare adverse outcomes may have been missed. Our aim is to quantify the frequency of short-term adverse outcomes of children with isolated skull fractures.
Methods:
PubMed, EMBASE, the Cochrane Library, Scopus, Web of Science, and gray literature were systematically searched to identify studies reporting on short-term adverse outcomes of children aged 18 years or younger with linear, nondisplaced, isolated skull fractures (ie, without traumatic intracranial injury on neuroimaging). Two investigators independently reviewed identified articles for inclusion, assessed quality, and extracted relevant data. Our primary outcome was emergency neurosurgery or death. Secondary outcomes were hospitalization and new intracranial hemorrhage on repeated neuroimaging. Meta-analyses of pooled estimate of each outcome were conducted with random-effects models, and heterogeneity across studies was assessed.
Results:
Of the 587 studies screened, the 21 that met our inclusion criteria included 6,646 children with isolated skull fractures. One child needed emergency neurosurgery and no children died (pooled estimate 0.0%; 95% confidence interval [CI] 0.0% to 0.0%; I2=0%). Of the 6,280 children with known emergency department disposition, 4,914 (83%; 95% CI 71% to 92%; I2=99%) were hospitalized. Of the 569 children who underwent repeated neuroimaging, 6 had new evidence of intracranial hemorrhage (0.0%; 95% CI 0.0% to 9.0%; I2=77%); none required operative intervention.
Conclusion:
Children with isolated skull fractures were at extremely low risk for emergency neurosurgery or death, but were frequently hospitalized. Clinically stable children with an isolated skull fracture may be considered for outpatient management in the absence of other clinical concerns.
... As 3-D reconstructions have become more common in recent years [10], the added diagnostic value of skull radiographs is unclear [11]. Frequently, children with suspected head trauma will be evaluated in emergency departments after hours when pediatric radiologists are unavailable, resulting in emergency department physicians initially reading skull radiographs and determining management. ...
... Prior data suggest that CT with 3-D reconstruction may be superior to skull radiographs in identifying skull fractures in infants with suspected abusive head trauma. The former modality has enhanced sensitivity and specificity [11,16], finding subtle fractures while also clarifying normal variants [13]. As seen in this study, when head CT with 3-D reconstruction was used in evaluating abusive head trauma, the presence or absence of skull fractures Fig. 2 A 6-month-old boy receiving a medical evaluation for macrocephaly was found to have a left frontal skull fracture noted on skull radiographs. ...
Background
Young children with suspected abusive head trauma often receive skull radiographs to evaluate for fractures as well as computed tomography (CT) of the head to assess for intracranial injury. Using a CT as the primary modality to evaluate both fracture and intracranial injury could reduce exposure to radiation without sacrificing performance. Objective
To evaluate the sensitivity of CT head with (3-D) reconstruction compared to skull radiographs to identify skull fractures in children with suspected abusive head trauma. Materials and methodsThis was a retrospective (2013-2014) cross-sectional study of infants evaluated for abusive head trauma via both skull radiographs and CT with 3-D reconstruction. The reference standard was skull radiography. All studies were read by pediatric radiologists and neuroradiologists, with ten percent read by a second radiologist to evaluate for interobserver reliability. ResultsOne hundred seventy-seven children (47% female; mean/median age: 5 months) were included. Sixty-two (35%) had skull fractures by radiography. CT with 3-D reconstruction was 97% sensitive (95% confidence interval [CI]: 89-100%) and 94% specific (CI: 87-97%) for skull fracture. There was no significant difference between plain radiographs and 3-D CT scan results (P-value = 0.18). Kappa was 1 (P-value <0.001) between radiologist readings of CTs and 0.77 (P = 0.001) for skull radiographs. ConclusionCT with 3-D reconstruction is equivalent to skull radiographs in identifying skull fractures. When a head CT is indicated, skull radiographs add little diagnostic value.
... Recent advances in CT technology have enabled high resolution image reconstructions with data acquired at thin slices (0.5 to 1.5 mm), and helical CT scanning using thin slices is now routine practice in many countries including the Emergency Medicine International 3 UK, North America, and Japan. These data can be obtained with multidetector devices, and they provide superior diagnosis rates compared to skull X-rays [3]. Thus, skull Xrays have largely been replaced by helical scanning using thin slices, and patients are managed without the risk of additional irradiation that amounts to approximately 7 mGy with three-directional skull X-rays. ...
. Images of head CT for the supratentorial compartment are sometimes recommended to be reconstructed with a thickness of 8–10 mm to achieve lesion conspicuity. However, additional images of a thin slice may not be routinely provided for patients with trauma in the emergency room (ER). We investigated the diagnostic sensitivity of a head CT, where axial images were 10 mm thick slices, in cases of linear skull fractures.
Methods
. Two trauma surgeons retrospectively reviewed head CT with 10 mm slices and skull X-rays of patients admitted to the ER that were diagnosed with a linear skull fracture. All patients had undergone both head CT and skull X-rays (
n
=
410
).
Result
. The diagnostic sensitivity of head CT with a thickness of sequential 10 mm was 89% for all linear skull fractures but only 56% for horizontal fractures. This CT technique with 10 mm slices missed 6% of patients with linear skull fractures. False-negative diagnoses were significantly more frequent for older (≥55 years) than for young (
... This is especially valid for depressed skull fractures and diastatic skull fractures. 5 For this reason, we have used 3D CT along with MRI venography for possible venous sinus injury, both during the patient's admission and follow-up. Also, CT venography can be used to diagnose the possible cerebral venous sinus pathologies and there is no consensus as to the superiority of MRI venography over CT venography to detect cerebral venous sinus injury. ...
A 7-year-old boy was admitted to the emergency department after closed head injury. Physical examination revealed no neurologic disturbances or scalp laceration. Computed tomography revealed depressed skull fracture on the right occipital bone with multiple fracture lines over the right transverse sinus. Magnetic resonance imaging revealed right transverse sinus thrombosis, and magnetic resonance venography identified total occlusion of the right transverse sinus due to bone compression. Despite the presence of venous sinus injury secondary to a depressed skull fracture, surgery was not indicated for this patient. Despite persistence of a right occipital depression fracture identified during a three-dimensional cranial tomography performed in the third month following the trauma, the patient’s magnetic resonance venography showed spontaneous recanalization of the right transverse sinus. It was demonstrated that venous sinus occlusion secondary to a depressed fracture could heal spontaneously and independently of bone pathology. With such characteristics, this report represents an extremely rare case.
Background: Head injury is a global health problem that can cause disability and may result in death. CT scan detects and precisely localizes the skull fractures, epidural/subdural/subarachnoid hemorrhages, brain contusions and cerebral edema etc. CT has proven to be a valuable tool in the early diagnosis and prompt management of head trauma patients and has resulted in significant improvement in morbidity and mortality. Methods: A descriptive cross-sectional study, including 380 patients, presented to Radiology Department of Hayatabad Medical Complex with a history of head trauma for computed tomography examination, from October 2019 to October 2020. The nature of the brain and skull lesions was analyzed in our study and the frequency of various findings was recorded. Results: Among 380 patients, the majority were males (248) making the male to female ratio to be around 2:1. The most prevalent finding was skull fractures (23.4%) followed by cerebral contusions (17.1%). Among extra-axial brain hemorrhages, extradural hematoma (15.2%) was observed more than subdural hematoma (6.8%) while only 3.4% presented with subarachnoid hemorrhages which also included intraventricular hemorrhages. Practical Implication: As road traffic accidents are the most common cause of head injuries so road traffic safety measures ought to be strictly enforced. Most of the CT scan done during head injuries were normal so CT guidelines for ordering should be implemented to scale back extra patient irradiation, unnecessary waste of resources and a further burden on the radiology department. Keywords: Head Injury, Computed Tomography (CT), Road Traffic Accidents (RTA), Skull Fractures, Epidural Hematoma.
