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Decision rule identifies children with skull fractures, reduces radiography
A new clinical decision rule, designed to assist physicians in evaluating minor head trauma in pediatric patients, successfully identified skull fractures in children without the use of radiological scanning, according to a recent study in CMAJ.
“We developed a clinical decision rule that identified about 90% of skull fractures among children less than 2 years old who had acute head trauma with no immediate indication for head tomography,” Jocelyn Gravel, MD, MSc, research director at Sainte-Justine hospital in Montreal, Canada, and colleagues wrote.
Jocelyn Gravel
The researchers studied pediatric patients admitted to three EDs in Canada from 2011 to 2014. The study was divided into two phases, with 811 children participating in the derivation phase and 856 participating in the validation phase. The researchers developed a decision tool based on 14 independent variables related to demographic characteristics, severity of the accident, apparent symptoms, apparent physical disparities and lacerations. This rule was applied to determine whether a skull fracture was present and confirmed via radiological evaluation.
Forty-nine patients had skull fractures in the derivation group. Among this group the decision rule had a sensitivity of 94% and a specificity of 86%. There were 44 skull fractures in the validation group, where the rule had a sensitivity of 89% and the specificity was 87%.
Overall, the researchers noted that the tool successfully identified approximately 90% of skull fractures. By using this tool, the researchers said, radiological screening could be reduced by about 60%. This would allow for better use of health care resources and avoid the time-consuming process of specialist referrals and cranial imaging.
“Even though the rule seems simple to use, an implementation study conducted in multiple settings would be necessary to ensure robust external validity and proper application of the rule in different clinical settings,” Gravel and colleagues wrote. – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
