Evaluation of guidelines for skull radiography in head injury

The benefits of utilisation of guidelines for radiographic skull examination of head injured patients were studied in one hundred and eleven patients. The causes of head injury were road traffic accidents (RTA) 87.4%, fall and assault 4.5% each, collapsed wall 1.8%, gunshot injury and industrial accident 0.9% each. RTA resulted predominantly from burst tyre 34%, vehicle pedestrian accidents 23.7% and vehicle collision 18.6%. Compliance with the use of the guidelines was 48%. Radiographic skull examination was carried out in 22 patients (20% of study population) and the positive yield for skull fracture was 32% (7/22 of all radiographs). At discharge, 14 of those who had radiographic examination (n=20) recovered without neurological complications while 39 among those not examined (n=58) similarly recovered, p=0.96. Among those who had skull radiography, neurological deficit occurred in 6 that had skull fractures (n=7) and in 5 of those without skull fractures (n=13), p=0.07. It was concluded that radiographic skull examination based on selective guidelines increases the yield of skull fractures and reduces unnecessary examinations, thereby saving costs. Skull radiography may not be predictive of neurological outcome of treatment. Cranial computed tomography (CT) should be obtained if available and clinically indicated.