title: Reducing unnecessary skull radiographs in children: a multidisciplinary audit.
abstract: OBJECTIVE
  To review guidelines on the indications for skull radiographs with a view to improving compliance and reducing unnecessary irradiation of children.
  
  
  METHODS
  Three audits on the indications, compliance and effect on practice of differing sets of guidelines for skull radiographs following paediatric head trauma were performed. After each audit, alterations in clinical practice with modifications of the guidelines were implemented. The effect of these changes on radiological practice and patient care were recorded. Audits were performed for 3 months (February-April) in 1999, 2001 and 2003.
  
  
  RESULTS
  The number of children with head injuries presenting was unchanged. The number of skull radiographs performed fell from 146 in 1999 to 95 in 2001 and 50 in 2003. Compliance with hospital guidelines increased from 85% in 1999 to 100% in 2003. No neurosurgical problems were missed.
  
  
  CONCLUSIONS
  The implementation of guidelines that are acceptable to all specialties will improve compliance and reduce unnecessary radiographs being performed. The involvement of the radiography staff will help maintain compliance. The training of junior staff and maintaining good communication with involved departments will improve patient care.
authors.affiliation: Radiology Department, Birmingham Children's Hospital, Birmingham, UK. karl.Johnson@bch.nhs.uk
authors.forename: K
authors.initials: K
authors.lastname: Johnson
authors.forename: S C
authors.initials: SC
authors.lastname: Williams
authors.forename: M
authors.initials: M
authors.lastname: Balogun
authors.forename: M S
authors.initials: MS
authors.lastname: Dhillon
mesh_terms: D002648:Child; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D008485:Medical Audit; D017410:Practice Guidelines as Topic / Q000592:standards; D011859:Radiography; D011872:Radiology Department, Hospital / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*