252 - Utility of Inpatient Cranial Ultrasound for Surveillance of Pediatric Patients with Mild to Moderate Computed Tomography Evident Traumatic Brain Injury

Publication Number: 2242.252

Noah S. Goldman, Cooper Medical School of Rowan University, Philadelphia, PA, United States; Cailey Talbot, Michigan State University College of Osteopathic Medicine, East Lansing, MI, United States; Isabella Armento, Cooper Medical School of Rowan University, Camden, NJ, United States; Krystal Hunter, Cooper Medical School of Rowan University, Camden, NJ, United States; Anna Goldenberg-Sandau, Cooper Medical School of Rowan University, Camden, NJ, United States; Alla Kushnir, Cooper Medical School of Rowan University, Camden, NJ, United States; Corey Mossop, Cooper Medical School of Rowan University, Camden, NJ, United States; Renata Ostrowicki, The Children's Regional Hospital at Cooper, Camden, NJ, United States; Emily Scattergood, Cooper Medical School of Rowan University, Camden, NJ, United States

Background: Traumatic brain injuries (TBIs) are a leading cause of hospitalization and death in young children, particularly those aged 0-4 years, with intracranial injuries occurring in up to 12% of pediatric trauma cases. CT and MRI remain gold standards but are limited by radiation, sedation, and resource burden. As a radiation-free bedside technique, cranial ultrasound (CUS) has been considered to mitigate these risks.

Objective: This study aimed to evaluate the utility of inpatient CUS for follow-up imaging in pediatric patients, ages 0-4, with mild to moderate TBI evident on CT.

Design/Methods: A retrospective chart review was conducted of all children ages 0-4 with Glasgow Coma Scale (GCS) scores of 9-15 and CT-confirmed SF and/or ICH, admitted to a level 1 adult and level 2 pediatric trauma center in New Jersey between January 1, 2014 and January 1, 2024. Collected data included demographics, length of stay, level of care, TBI characterization, imaging methods used, and 30-day readmission. Charts of patients receiving CUS were reviewed for imaging findings and associated change in management. Data was compared with Chi Square and Fischer Exact Tests with significance established at P < 0.05.

Results: Of the 329 patients, 69 (21%) received CUS with only 4 leading to an associated change in management. Among these cases, all four had bilateral ICH (P = 0.003) with lack of SF (P = 0.012). Overall, patients who underwent CUS had longer ICU (P < 0.001) and overall hospital length of stays (P = 0.015) compared to those without. Additionally, there was no statistically significant change in 30-day readmission.

Conclusion(s): CUS demonstrates limited clinical utility, with longer hospital stays and no changes in management or improvement in readmission. Although not statistically significant, management changes occurred primarily in infants with moderately sized supratentorial ICH—patients with optimal ultrasound windows. These findings support selective use of CUS with clinical monitoring the most effective guide for inpatient imaging decisions in pediatric TBI.