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Is a skull X-ray necessary after milder head trauma?
J Rosenørn1, B Duus, K Nielsen
1University Clinic of Neurosurgery, Copenhagen County Hospital, Glostrup, Denmark.
British Journal of Neurosurgery
|January 1, 1991
Summary
Routine skull X-rays are not recommended for milder head trauma patients. The study found no significant difference in intracranial complications between patients with and without skull X-rays, suggesting unnecessary imaging.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Milder head trauma, including cerebral concussion, is a common reason for hospital admission.
- The utility of skull X-rays in evaluating intracranial complications after mild head injury remains a subject of debate.
Purpose of the Study:
- To evaluate the necessity of routine skull X-rays in patients presenting with milder head trauma.
- To determine if skull X-rays correlate with a higher incidence of significant intracranial complications.
Main Methods:
- Retrospective analysis of 1,876 patients admitted for milder head trauma between 1985-86.
- Comparison of intracranial complication rates in patients who underwent skull X-rays versus those who did not.
- Correlation of skull X-ray findings (fracture vs. no fracture) with CT-verified intracranial complications.
Main Results:
- In 1,592 patients without skull X-rays, six (0.38%) developed intracranial complications.
- In 284 patients with skull X-rays, 25 had fractures; one (4%) had a cerebral contusion. Of the 259 without fractures, two (0.77%) had intracranial complications.
- The incidence of intracranial complications did not significantly differ between groups with or without skull X-rays, irrespective of fracture status.
Conclusions:
- Routine skull X-ray imaging after milder head trauma does not appear to be justified.
- Clinical guidelines should reconsider the routine use of skull X-rays in mild head injury cases.
- CT scans remain crucial for diagnosing intracranial complications when clinically indicated.