Gravel and colleagues describe the derivation and validation of a clinical rule to identify skull fractures in children with isolated head trauma.1 Their study identified young age (< 2 months) and parietal or occipital hematoma as predictors of skull fracture on skull x-rays.
However, the article and the accompanying commentary2 ignore a safer tool that minimizes unnecessary radiation exposure in children who have suffered a minor head injury: point of care ultrasound (POCUS).
POCUS can be used at the bedside to rapidly identify a skull fracture without the use of radiation. It has been shown to have a sensitivity of 82% to 100% and a specificity of 94% to 97% for identifying skull fractures in children compared with computerized tomography scans.3–5 The technique for POCUS may be learned in as little as one hour of combined didactic and hands-on training.4
Not only do skull x-rays carry radiation risk, they may be more difficult to interpret. Chung and colleagues found that skull x-rays had a sensitivity of 76% and a specificity of 84% for identifying skull fractures when interpreted by pediatric emergency physicians.6