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Actually CT's can be questionable in the assessment of some skull fractures. Isn't that why there's a push towards Ultrasound in these scenarios? Guess that's going to be operator/experience dependent in terms of the quality of your result. Would still be a good thing given the concern over additional radiation exposures.

DLooneyMD

> Date: Fri, 1 Jun 2012 20:18:54 -0400
> From: [log in to unmask]
> Subject: Re: skull fracture added question
> To: [log in to unmask]
> 
> The likelihood on day 4 of having a clinically important bleed seems pretty
> low. However, the likelihood of having a skull fracture (prior to the
> x-rays) seems reasonably high. While in most cases, there's nothing you'd
> do about a non-depressed skull fracture, I think it's still worth knowing
> about. There's a low-likelihood but real possibility of non-union, which
> puts the child at risk for a growing fracture/leptomeningeal cyst. It'd be
> worth it to me to know of the fracture, and monitoring for this outcome as
> the fracture heals (my N=1 experience as the parent in this situation
> probably informs this opinion to some degree!).
> 
> An additional question is how reliable are plain films for determining
> depressed vs. non-depressed skull fracture. My guess (and it's exactly
> that) is that plain films aren't reliable, which makes me wonder if the CT
> might be worthwhile. I could be convinced otherwise, though.
> 
> Best,
> Chris
> 
> On Fri, Jun 1, 2012 at 5:07 PM, Gill Winnik <[log in to unmask]>wrote:
> 
> > If those kids would have presented to you, as before, on day 4 with this
> > large parietal swelling  and looking good would you have done ANY imaging???
> > Giora
> > ________________________________________
> > From: Pediatric Emergency Medicine Discussion List [
> > [log in to unmask]] on behalf of James Wilson [
> > [log in to unmask]]
> > Sent: Friday, June 01, 2012 2:21 PM
> > To: [log in to unmask]
> > Subject: Re: mastoiditis imaging
> >
> > Kathy,
> > We punt to CT, with immediate call to ENT.  Slightest sign of neuro
> > changes we move to LP.  As a point of note, we've seen quite a bit of
> > Pseudomonas, MRSA, and one case of venous cavernous sinosus thrombosis out
> > our way.  In regards to MRSA, noting kids getting their ear tubes
> > contaminated, which precipitates removal... Then you find out they've been
> > sitting in school for a week or so with goo dripping out the ear, onto the
> > shirt, on their hands/desk/whatever.
> > Jim Wilson, MD
> > Pediatrics
> > Delta CO
> >
> > On Jun 1, 2012, at 11:20 AM, Mohammed <[log in to unmask]> wrote:
> >
> > > The prolonged hx while on antibiotics is worrisome.
> > > Our colleagues ENT definitely will ask for CT
> > > Best Regards
> > >
> > > M Alomar
> > > Riyadh, Saudi Arabia
> > >
> > > On Jun 1, 2012, at 5:29 PM, neil mullen <[log in to unmask]> wrote:
> > >
> > >> DDX exists.  Image.
> > >>
> > >>
> > >>
> > >> ________________________________
> > >> From: "Goetz, Kathleen" <[log in to unmask]>
> > >> To: [log in to unmask]
> > >> Sent: Friday, June 1, 2012 12:19 AM
> > >> Subject: mastoiditis imaging
> > >>
> > >> 9 month old healthy immunized child with 17 days OM.  Treated with
> > Amoxil x 7 days, cefdinir x 10 days, presents with protruding right ear,
> > suppurative ROM, post auricular erythema, fever, otherwise well appearing.
> > >> Would you image this child who has clinical mastoiditis?
> > >> If so - CT?
> > >> Has your practice changed due to increasing concerns about CT/radiation
> > exposure in infants?
> > >> Kathey Goetz
> > >>
> > >> Kathleen Goetz, MD
> > >> Medical Director
> > >> Swedish Pediatric Emergency Services
> > >> Office:  206-386-3313  ED:  206-386-2573  Cell: 253-370-7571
> > >>
> > >>
> > >>
> > >> For more information, send mail to [log in to unmask] with
> > the message: info PED-EM-L
> > >> The URL for the PED-EM-L Web Page is:
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> > >>
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> > >>
> > >
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> 
> 
> 
> -- 
> Chris Merritt, MD, MPH, FAAP
> Pediatric Emergency Medicine
> Hasbro Children's Hospital
> Alpert Medical School, Brown University
> [log in to unmask]
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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