Can we abolish skull x rays for head injury?
OBJECTIVE
To assess the effect of a change in skull x ray policy on the rate of admission, use of computed tomography (CT), radiation dose per head injury, and detection of intracranial injuries; and to compare the characteristics of patients with normal and abnormal head CT.


METHODS
Retrospective cohort study.


METHODS
UK paediatric teaching hospital emergency department.


METHODS
1535 patients aged between 1 and 14 years with a head injury presenting to the emergency department between 1 August 1998 and 31 July 1999 (control period), and 1867 presenting between 1 August 2002 and 31 July 2003 (first year of new skull x ray policy).


METHODS
Hospital notes and computer systems were analysed and data were collected on all patients presenting with a head injury.


RESULTS
The abolition of skull x rays in children aged over 1 year prevented about 400 normal skull x rays being undertaken in period 2. The percentage of children undergoing CT rose from 1.0% to 2.1% with no change in the positive CT pick up rate (25.6% v 25.0%). There was no significant change in admission rate (10.9% v 10.1%), and a slight decrease in the radiation dose per head injury (0.042 mSv compared to 0.045 mSv).


CONCLUSIONS
Skull x rays can be abandoned in children aged 1 to 14 without a significant increase in admission rate, radiation dose per head injury, or missed intracranial injury. The mechanism and history of the injury and a reduced Glasgow coma scale are probably the most important indicators of significant head injury in children.
Reed
M J
MJ
Accident and Emergency Department, Royal Hospital for Sick Children, Edinburgh, UK. mattreed1@hotmail.com
Browning
J G
JG
Wilkinson
A G
AG
Beattie
T
T
D000059:Accidents; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D004630:Emergencies; D005260:Female; D015600:Glasgow Coma Scale; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D011829:Radiation Dosage; D012189:Retrospective Studies; D012886:Skull / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D019564:Unnecessary Procedures; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging