Increasing the diagnostic yield of portable skull films

A three-year retrospective analysis was conducted at a 280-bed suburban community hospital with 27,000 annual emergency department visits. All patients with a discharge diagnosis of skull fracture were studied. There were 72 patients with skull fractures. Thirty-two (44.4%) of these patients had basilar skull fractures, located predominantly in the occipital bone. Of these, 19 (59.3%) had normal antero-posterior and lateral views, with the skull fracture detected only on the Towne view. Five of these patients had depressed skull fractures and three had intracranial lesions requiring surgical intervention. We conclude that, when the decision is made to obtain portable skull films, a Towne view must be included, as well as the antero-posterior and lateral views, to increase the diagnostic yield of portable skull films in patients with skull fractures.