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Neonatal cranial ultrasound interpretation: a clinical audit
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Abstract

OBJECTIVE To assess the abilities of doctors to interpret neonatal cranial ultrasound scans.

DESIGN AND SETTING High resolution scanned images of six important neonatal cranial ultrasound abnormalities were posted as a questionnaire to the 59 neonatal units in the North and South Thames regions.

RESULTS Forty two questionnaires were returned (71%). Currently 56% of those interpreting cranial ultrasound scans are neonatal registrars, 27% are consultant paediatricians or neonatologists, and 17% are radiologists. The response rate from registrars was excellent (97%), but it was poor from consultant paediatric (38%) and radiological (40%) staff. The mean accurate identification of cerebral abnormalities was only 59% (range 45–71%). Only 44% of the neonatal registrars, compared with nearly all the consultant staff, have had any formal training in cranial ultrasonography.

CONCLUSIONS The data highlight the current accuracy of neonatal cranial ultrasound scan reporting in the Greater London region and have important implications for clinical services and research studies. Doctors who are responsible for interpreting neonatal cranial ultrasound scans should have formal training and supervision, and more formal reporting would improve and maintain standards. The findings raise significant doubts about the accuracy of local interpretation of cranial ultrasound scans in multicentre research studies.

  • neonatal
  • cranial
  • ultrasound scans
  • interpretation
  • reporting
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Supplementary materials

  • Questions for:
    Neonatal cranial ultrasound interpretation: a clinical audit reference
    Arch Dis Child Fetal Neonatal Ed 2001;84:F92-5

    Instructions for use

    All pictures have been taken using standard cranial ultrasound settings, with a variable probe set at 7.5 MHz unless otherwise specified.
     

    • Abnormalities: Please name all the abnormalities seen (often there is more than one). The scan may be normal. Be as explicit as you are able.
    • Management plan: Please specify your management intentions. Be as specific and realistic as you can.
    • Prognosis: Please specify prognosis (good/guarded/poor). In addition to this, express what this may mean for the childs development. Be specific and realistic.


    QUESTION 1
      GIF Image

    This is the cranial ultrasound of a 27 week infant, taken on day 2 after birth

    1. What abnormalities are shown?
    2. What is your management plan?
    3. What prognosis would you give the parents?


    QUESTION 2
      GIF Image

    This is the cranial ultrasound of a 33 week gestation infant with jaundice, taken 14 days after birth

    1. What abnormalities are shown?
    2. What is your management plan?
    3. What prognosis would you give the parents?


    QUESTION 3
      GIF Image

    This is the cranial ultrasound of a 26 week infant taken at day 21 after birth

    1. What abnormalities are shown?
    2. What is your management plan?
    3. What prognosis would you give the parents?


    QUESTION 4
      GIF Image

    This is the cranial ultrasound of an ex-28 week infant who is now at a corrected gestational age of 35 weeks
     

    1. What abnormalities are shown?
    2. What is your management plan?
    3. What prognosis would you give the parents?


    QUESTION 5
      GIF Image

    This is the cranial ultrasound scan of a 29 week infant taken 7 days after birth
     

    1. What abnormalities are shown?
    2. What is your management plan?
    3. What prognosis would you give the parents?
    QUESTION 6
      GIF Image

    This term infant was born by emergency caesarian section for fetal distress. The above scan was taken at 24 hours of age

    At the same time, the following scans were taken using the 5MHz setting
      GIF Image
      GIF Image

    1. What abnormalities are shown?
    2. What is your management plan?
    3. What prognosis would you give the parents?
    4. Why were the 5MHz images obtained?

    ANSWERS

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