Diagnostic Accuracy of Ultrasonography for Identification of Skull Fracture in Children: A Systematic Review and Meta-analysis

Introduction: There is no consensus on the diagnostic performance of ultrasonography for identifying skull fractures in children, and the accuracy of this imaging modality in this age group has been questioned. This study performed a pooled analysis to explore the diagnostic performance characteristics of ultrasonography in this regard. Methods: Three databases, Web of Science, Medline, and Scopus, were systematically searched from their inception through August 2025. Data extraction of diagnostic parameters was performed by two independent authors. Pooled estimates of the diagnostic parameters were calculated using Meta-Disc software and the MIDAS package of Stata. Results: The estimated sensitivity of ultrasonography for detecting skull fracture in children was 0.89 (95% confidence interval (CI): 0.86–0.92), and the specificity was 0.97 (95% CI: 0.96–0.98). The estimated positive likelihood ratio (PLR) was 23.21 (95% CI: 14.84–36.32), while the negative likelihood ratio (NLR) was 0.13 (95% CI: 0.09–0.20). The diagnostic odds ratio (DOR) was 208.89 (95% CI: 112.68–387.27), and the estimated overall diagnostic accuracy of ultrasonography was 0.96. Conclusion: Ultrasonography demonstrated high diagnostic accuracy for identifying skull fractures in children, with evidence indicating stronger performance for confirmation than for exclusion. However, the high risk of bias in patient selection across the studies limits the generalizability of the evidence, and the results should therefore be interpreted with appropriate caution.