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How useful is the skull x-ray examination in trauma?
The Medical Journal of Australia
|November 15, 1980
Summary
Skull X-ray examinations for head trauma are rarely positive (2.3%) and seldom alter treatment (0.6%). Clinical evaluation is more reliable for diagnosing intracranial injury than skull X-rays.
Area of Science:
- Radiology
- Trauma Surgery
- Emergency Medicine
Background:
- Skull X-ray examinations are frequently used in evaluating patients with suspected head trauma.
- The diagnostic yield and clinical impact of these examinations are often questioned.
Observation:
- Only 2.3% of 1053 skull X-rays showed abnormalities.
- Treatment was influenced in only 0.6% of cases.
- The cost per positive finding was high at $1461.
Findings:
- Skull X-ray is not a reliable indicator of intracranial injury.
- Specific clinical criteria can reliably select patients for X-ray, particularly for suspected fractures or foreign bodies.
- Radiological findings had minimal impact on patient management.
Implications:
- Routine skull X-rays may not be cost-effective for undifferentiated head trauma.
- Clinical assessment and observation are paramount for managing head injuries.
- A restrictive policy on skull X-rays has medicolegal considerations.