@article {Reed859, author = {M J Reed and J G Browning and A G Wilkinson and T Beattie}, title = {Can we abolish skull x rays for head injury?}, volume = {90}, number = {8}, pages = {859--864}, year = {2005}, doi = {10.1136/adc.2004.053603}, publisher = {BMJ Publishing Group Ltd}, 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.}, issn = {0003-9888}, URL = {https://adc.bmj.com/content/90/8/859}, eprint = {https://adc.bmj.com/content/90/8/859.full.pdf}, journal = {Archives of Disease in Childhood} }