• 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, and Andrea T Cruz.
• Section of Public Health Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St., Suite A2275, Houston, TX, 77030, USA. paculott@texaschildrens.org.
• Pediatr Radiol. 2017 Jan 1; 47 (1): 74-81.

BackgroundYoung children with suspected abusive head trauma often receive skull radiographs to evaluate for fractures as well as computed tomography (CT) of the head to assess for intracranial injury. Using a CT as the primary modality to evaluate both fracture and intracranial injury could reduce exposure to radiation without sacrificing performance.ObjectiveTo evaluate the sensitivity of CT head with (3-D) reconstruction compared to skull radiographs to identify skull fractures in children with suspected abusive head trauma.Materials And MethodsThis was a retrospective (2013-2014) cross-sectional study of infants evaluated for abusive head trauma via both skull radiographs and CT with 3-D reconstruction. The reference standard was skull radiography. All studies were read by pediatric radiologists and neuroradiologists, with ten percent read by a second radiologist to evaluate for interobserver reliability.ResultsOne hundred seventy-seven children (47% female; mean/median age: 5 months) were included. Sixty-two (35%) had skull fractures by radiography. CT with 3-D reconstruction was 97% sensitive (95% confidence interval [CI]: 89-100%) and 94% specific (CI: 87-97%) for skull fracture. There was no significant difference between plain radiographs and 3-D CT scan results (P-value = 0.18). Kappa was 1 (P-value <0.001) between radiologist readings of CTs and 0.77 (P = 0.001) for skull radiographs.ConclusionCT with 3-D reconstruction is equivalent to skull radiographs in identifying skull fractures. When a head CT is indicated, skull radiographs add little diagnostic value.

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