Four-film X-ray series is more sensitive than 2-film for diagnosis of skull fractures in children.

Abstract

OBJECTIVE:

The objective of this study was to compare the sensitivity and specificity of 2- and 4-film x-ray series when interpreted by pediatric emergency medicine physicians in the diagnosis of skull fracture in children.

METHODS:

A noninferiority crossover study was performed. The skull radiographs of the 50 most recent cases of skull fracture for which a 4-film radiography series was available and 50 controls matched for age were reviewed. Two modules, containing a random sequence of 2- and 4-film series of each child, were constructed to have all children evaluated twice (once with 2 films and once with 4 films). Pediatric emergency physicians evaluated both modules 2 to 4 weeks apart. The interpretation of the 4-film series by a pediatric radiologist served as the criterion standard. The sensitivity and specificity of the 2-film versus the 4-film skull x-ray series, in the identification of fracture, were compared.

RESULTS:

Thirteen pediatric emergency physicians participated in the study. For sensitivity, the mean difference between the 2- and 4-view series was higher than the noninferiority margin of 0.055 with an absolute mean difference of 0.060 (4-view minus 2-view series) and a 1-sided 95% higher confidence limit of 0.099. However for specificity, the mean difference was within the margin with an absolute mean difference of 0.011 and a 1-sided 95% higher confidence limit of 0.033.

CONCLUSIONS:

For children sustaining a head trauma, the 2-film skull radiography series is not as sensitive as the 4-film series in the detection of fracture, when interpreted by pediatric emergency physicians.

• Authors: Jessica Morrison, Benoît Mâsse, Philippe Ouellet, Jean-Claude Décarie, Jocelyn Gravel
• Journal: Pediatric emergency care (Pediatr Emerg Care) Vol. 29 Issue 11 Pg. 1189-93 (Nov 2013) ISSN: 1535-1815 [Electronic] United States
• PMID: 24168880 (Publication Type: Evaluation Study, Journal Article)

Topics

• Child, Preschool
• Craniocerebral Trauma (diagnostic imaging)
• Cross-Over Studies
• Diagnostic Errors
• Emergency Medicine
• Emergency Service, Hospital
• Female
• Humans
• Infant
• Infant, Newborn
• Male
• Observer Variation
• Pediatrics
• Physicians (psychology)
• Radiography
• Radiology
• Reproducibility of Results
• Retrospective Studies
• Sensitivity and Specificity
• Skull Fractures (diagnostic imaging)