Jessica Morrison1, Benoît Mâsse, Philippe Ouellet, Jean-Claude Décarie, Jocelyn Gravel. 1. From the *Department of Pediatrics, Sainte-Justine UHC, and †Sainte-Justine UHC Research Institute, University of Montréal, Montréal; ‡Université Laval, Québec, Québec, Canada; and §Department of Radiology, Sainte-Justine UHC, University of Montréal, Montréal, Québec, Canada.
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.
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: Paige A Culotta; James E Crowe; Quynh-Anh Tran; Jeremy Y Jones; Amy R Mehollin-Ray; H Brandon Tran; Marcella Donaruma-Kwoh; Cristina T Dodge; Elizabeth A Camp; Andrea T Cruz Journal: Pediatr Radiol Date: 2016-10-15
Authors: Andrew W Kiragu; Stephen J Dunlop; Benjamin W Wachira; Seno I Saruni; Michael Mwachiro; Tina Slusher Journal: J Pediatr Intensive Care Date: 2016-06-24
Authors: Andrew W Kiragu; Stephen J Dunlop; Njoki Mwarumba; Sanusi Gidado; Adesope Adesina; Michael Mwachiro; Daniel A Gbadero; Tina M Slusher Journal: Front Pediatr Date: 2018-06-04 Impact factor: 3.418