title: The use of skull X-rays in head injury in the emergency department--a changing practice.
abstract: BACKGROUND
  This is a consequential study of a previous audit, evaluating the role of skull X-rays in the emergency department in patients with head injuries, to see if the changes recommended, (implementation of The Royal College of Surgeons of England guidelines) have been adopted successfully and had the desired result.
  
  
  METHODS
  All patients who attended the accident and emergency department at the Royal Berkshire Hospital from 1-30 November 2003 with a diagnosis of head injury had their notes analysed for indications for skull X-ray, presence of fracture and outcome.
  
  
  RESULTS
  278 patients were identified as having a head injury and had notes available, 19% (54/278) of these patients had a skull X-ray, of whom 31% (17/54) had a clearly documented indication. This shows a marked improvement from the previous audit when 50% (193/385) had a skull X-ray with only 7% (14/193) having a clearly documented indication.
  
  
  CONCLUSIONS
  Following the introduction of new guidelines, a clear improvement in the practice of evidence-based medicine has been achieved; however, there is still room for further improvement and on-going education of staff and auditing of performance will help to ensure this continues.
authors.affiliation: Accident and Emergency Department, Royal Berkshire Hospital Reading, UK.
authors.forename: David
authors.initials: D
authors.lastname: Mossop
authors.forename: Shanti
authors.initials: S
authors.lastname: Soysa
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging; D004636:Emergency Service, Hospital; D004739:England; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000706:statistics & numerical data*; D012887:Skull Fractures / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D019564:Unnecessary Procedures / Q000706:statistics & numerical data