[Diagnostic utility of radiography in head trauma: a critical review of the literature].
BACKGROUND
The indication of distinct imaging studies in pediatric head trauma, and especially the use of skull radiography, is controversial.


OBJECTIVE
To assess the effectiveness of skull radiography in the management of head trauma in pediatric patients. To do this, we aimed to determine the predictive value of this procedure in detecting intracranial injuries, independently of patients' symptoms and clinical examination.


METHODS
We performed a review of the medical literature (MEDLINE) and of other resources available for searching biomedical information. Studies limited to pediatric patients (0-18 years old) that provided information on the diagnostic utility of skull radiography in head injury were selected. The source and characteristics of the populations studied and potential design limitations were taken into account.


RESULTS
Twelve original studies were selected, three of which were performed in children younger than two years old. Differences were found in the origin of the sample populations, the prevalence of intracranial injury and skull fracture, the severity of the trauma included, and in the criteria for performing imaging tests.


CONCLUSIONS
Because of the limited comparability of the articles, the usefulness of skull radiography was difficult to assess. Although the use of this technique is accepted in some circumstances in patients younger than two years old, the data obtained assign little value to the systematic use of radiography to assess head trauma in pediatric patients. Head computed tomography is indicated when symptoms or signs of possible neurological injury are present.
Alcalá Minagorre
P J
PJ
Servicio de Pediatría, Hospital General Universitario de Alicante, Maestro Alonso 109, 03010 Alicante, Spain. palcala@wanadoo.es
Aranaz Andrés
J
J
Flores Serrano
J
J
Asensio García
L
L
Herrero Galiana
A
A
D000293:Adolescent; D001930:Brain Injuries / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D011237:Predictive Value of Tests; D011859:Radiography; D012887:Skull Fractures / Q000000981:diagnostic imaging