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Ability of emergency ultrasonography to detect pediatric skull fractures: a prospective, observational study

Methodology Score: 3.5/5                          
Usefulness Score: 3.5/5
Parri N, Crosby BJ, Glass C, Mannelli F, Sforzi I, Schiavone R, Ban KM.
J Emerg Med. 2013 Jan;44(1):135-41.


This single center prospective study of 55 children found that with minimal training, emergency physicians could detect pediatric skull fractures with a sensitivity of 100% (95% CI 88.2-100%) and a specificity of 95% (95% CI 75.0-99.9%) as compared to CT scan. The group discussed that if reproduced with larger studies, this study could potentially change management for infants under 24 months of age where ruling out a skull fracture by ultrasound could prevent them from needing to undergo a CT Scan.  
By: Dr. Mélissa Langevin
(Presented April 2013)

Epi Lesson – The Importance of Specificity
While ED physicians are appropriately concerned that tests used to rule out serious illness have very high sensitivity, we also must be concerned about specificity. If a screening test has a low specificity, it will not reduce use of more invasive or costly tests – be sure to note both the estimated specificity but also the 95% CIs. 
By: Ian Stiell

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