Article Text

Download PDFPDF

Can we abolish skull x rays for head injury?
Free
  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; mattreed1hotmail.com

Abstract

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
View Full Text

Statistics from Altmetric.com

Footnotes

  • Published Online First 25 April 2005

  • Competing interests: none declared

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles