Diagnostic Accuracy of Point-of-Care Cranial Ultrasound for Initial Assessment of Infants Without Suspected Trauma in the Pediatric Emergency Department

Abstract

Background

Cranial point-of-care ultrasound (POCUS) has shown efficacy for traumatic intracranial hemorrhage in pediatric emergency care. However, reports of its use in patients without trauma are limited.

Objectives

This study aimed to assess the diagnostic accuracy of cranial POCUS for identifying intracranial pathologies in infants without a history of trauma in a pediatric emergency department (PED).

Methods

This retrospective, observational study was conducted in the PED of a tertiary children’s hospital between March 2020 and March 2024. Pediatric patients aged <2 years without a history of trauma who underwent cranial POCUS were included in the study. Pediatric patients with suspected traumatic brain injuries who underwent cranial POCUS were excluded. The cranial POCUS was performed by trained pediatric emergency physicians. Neuroradiological imaging including computed tomography, magnetic resonance imaging, and radiology department ultrasound was used as the reference standard. If patients did not undergo neuroradiological imaging, clinical follow-up was used as a surrogate to detect the likelihood of serious intercranial pathologies.

Results

During the study period, 75 patients underwent cranial POCUS, and 51 were included in the analyses. The median age was 2 months, [interquartile range; 0 to 5 months]. Seizures (20/52), and apnea (8/52) were the common indications for cranial POCUS. The sensitivity and specificity of cranial POCUS were 40.0% (95% confidence interval [CI]; 13.4–56.1%) and 97.8% (95% CI; 94.9–99.6%), respectively.

Conclusions

Cranial POCUS performed by pediatric emergency physicians demonstrated high specificity for identifying intracranial pathologies in infants without trauma in the PED. However, the sensitivity of this method was low.