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Can we abolish skull x rays for head injury?
  1. M J Reed1,
  2. J G Browning1,
  3. A G Wilkinson2,
  4. T Beattie1
  1. 1Accident and Emergency Department, Royal Hospital for Sick Children, Edinburgh, UK
  2. 2Radiology Department, Royal Hospital for Sick Children, Edinburgh
  1. Correspondence to:
    Matthew J Reed
    Accident and Emergency Department, Royal Hospital for Sick Children, Sciennes Road, Edinburgh, UK;


Objectives: 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.

Design: Retrospective cohort study.

Setting: UK paediatric teaching hospital emergency department.

Patients: 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).

Intervention: 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.

  • NAI, non-accidental injury
  • NICE, National Institute for Clinical Effectiveness
  • SIGN, Scottish Intercollegiate Guideline Network
  • head injury
  • skull x ray
  • computed tomography

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  • Published Online First 25 April 2005

  • Competing interests: none declared

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