Aim: To evaluate the diagnostic accuracy and clinical utility of cranial ultrasound in detecting skull fractures in children with head trauma, with computed tomography as the reference standard, and to assess the impact of imaging findings on hospital admission and management decisions. Material and methods: This retrospective single-center observational study included 619 pediatric patients (0–14 years) presenting with head trauma to a pediatric hospital between 2020 and 2025. All patients underwent cranial ultrasound, and a subset subsequently underwent computed tomography. Suspected fractures were analyzed as positive findings for diagnostic purposes. Diagnostic accuracy metrics were calculated using computed tomography as the reference. Associations between clinical variables and outcomes were analyzed using appropriate nonparametric and categorical tests. Results: Among 619 children, 62 ultrasound examinations were classified as positive or suspected for fracture. Computed tomography was performed in 13 cases, most frequently in preschool-aged children. When compared with computed tomography, ultrasound demonstrated 100.0% sensitivity, 63.6% specificity, 33.3% positive predictive value, and 100.0% negative predictive value. Overall, 101 patients were hospitalized, including all patients with ultrasound-confirmed fractures and most with suspected fractures. Admission was significantly associated with younger age and trauma mechanism. All patients were managed conservatively and discharged without complications. Conclusions: Cranial ultrasound may serve as a safe, rapid, and accessible first-line imaging modality in the emergency setting for detecting skull fractures in children. Although specificity in this cohort was moderate, ultrasound showed a high negative predictive value, supporting its role in reducing unnecessary computed tomography scans and radiation exposure. Computed tomography should remain reserved for clinically ambiguous cases or those with persistent symptoms.