Infant cranial ultrasound: Applying practice development principles to enhance service delivery

AimTo explore the potential for local delivery of evidence based practice by supplementing a secondary care infant cranial ultrasound protocol with one used at a tertiary referral centre.MethodA single practitioner used ‘Practice Development’ methodology to learn, implement and evaluate the impact of adding supplementary (postero-lateral) fontanelle scanning to the anterior fontanelle infant cranial ultrasound examination routinely used at one District General Hospital (DGH). Over a 7 week period (March and April 2010) twenty one infants were scanned using both the routine (anterior fontanelle) and the new (additional postero-lateral fontanelle) technique. Images were evaluated by an independent tertiary referral centre expert (consultant neuroradiologist) to compare posterior cranial fossa visualisation and obtain a diagnostic second opinion. Pathology prevalence, posterior fossa visualisation and diagnostic agreement between local and tertiary referral opinions were compared.ResultsVisualisation of the posterior cranial fossa was considered to be subjectively improved for the multiple fontanelle technique. The required associated increase in overall examination time did not necessitate additional infant handling. This small pilot study did not show any statistically significant improvement in intracranial pathology detection.ConclusionThis study suggests that provision of multiple fontanelle scanning is practically feasible in a secondary care setting. Continued monitoring of diagnostic outcomes is required to assess its clinical value.