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The utility of post-traumatic skull X-rays.

D F Gorman1

  • 1Accident and Emergency Department, Chester Royal Infirmary, England.

Archives of Emergency Medicine
|September 1, 1987
PubMed
Summary

Clinical signs are often unreliable for diagnosing skull fractures in head injury patients. Skull X-rays remain a valuable tool for identifying fractures, especially in children, due to diagnostic limitations.

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Area of Science:

  • Emergency Medicine
  • Radiology
  • Trauma Surgery

Background:

  • Head injuries are common presentations to accident and emergency departments.
  • Accurate diagnosis of skull fractures is crucial for appropriate patient management.
  • Clinical assessment alone may not reliably detect all skull fractures.

Purpose of the Study:

  • To identify clinical characteristics associated with skull fractures in head-injured patients.
  • To evaluate the diagnostic accuracy of these characteristics for detecting skull fractures.
  • To inform guidelines on the use of skull radiography in head injury management.

Main Methods:

  • Retrospective analysis of 12,395 patients with head injuries over two 12-month periods.
  • Identification of clinical features significantly more common in patients with radiologically confirmed skull fractures.
  • Assessment of the diagnostic power of identified clinical characteristics.

Main Results:

  • Identified characteristics included recent alcohol consumption, initial unconsciousness, amnesia, vomiting, neurological signs, and injury mechanisms (pedestrian, motorcyclist, cyclist).
  • These clinical features demonstrated limited value in accurately diagnosing skull fractures, particularly in children.
  • Clinical diagnosis of radiologically apparent fractures was often not possible in individual patients.

Conclusions:

  • Clinical assessment alone is insufficient for reliably diagnosing skull fractures in most head-injured patients.
  • Skull X-rays should be utilized judiciously in the management of head injuries due to the limitations of clinical diagnosis and the risks associated with fractures.
  • Continued use of skull radiography is recommended for accurate fracture detection.

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