[The value of conventional skull x-rays after head injuries]

A retrospective study was used in an attempt to clarify whether skull fractures or clinical findings can be used for diagnosing intracranial injuries and which clinical features indicate that skull X-rays are unnecessary. 78 patients (1.5%) had a skull fracture and 41 patients (0.8%) had suffered intracranial injuries. Of 57 patients with skull fractures, 40% (23) showed evidence of intracranial injury and 60% (34) did not. Amongst 41 patients with intracranial injuries, 44% (18) failed to show a skull fracture. Patients with a skull fracture (without intracranial injury) showed just as many symptoms as patients without skull fracture. Patients with intracranial injuries most commonly showed neurological deficits, unconsciousness, or required intubation. Any one of these criteria or a combination of these indicated the presence of intracranial injury with a high degree of probability. These criteria permit economy with skull X-rays and indicate when to use other diagnostic means (CT). For this the patient should be mentally quite normal. There should be a definite history and a reliable observation period of 24 hours.