Can we abolish skull x rays for head injury?. Issue 8 (25th April 2005)

• Record Type: Journal Article
• Authors: Reed, M J; Browning, J G; Wilkinson, A G; Beattie, T
• Is Part Of: Archives of disease in childhood. Volume 90:Issue 8(2005)
• Page Start: 859
• Page End: 864
• Publication Date: 2005-04-25
• Subjects: NAI, non-accidental injury -- NICE, National Institute for Clinical Effectiveness -- SIGN, Scottish Intercollegiate Guideline Network; head injury -- skull x ray -- computed tomography; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/adc.2004.053603
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Objectives: To assess the effect of a change in skull x ray policy on the rate of admission, use of computed tomography (CT), radiation dose per head injury, and detection of intracranial injuries; and to compare the characteristics of patients with normal and abnormal head CT. Design: Retrospective cohort study. Setting: UK paediatric teaching hospital emergency department. Patients: 1535 patients aged between 1 and 14 years with a head injury presenting to the emergency department between 1 August 1998 and 31 July 1999 (control period), and 1867 presenting between 1 August 2002 and 31 July 2003 (first year of new skull x ray policy). Intervention: Hospital notes and computer systems were analysed and data were collected on all patients presenting with a head injury. Results: The abolition of skull x rays in children aged over 1 year prevented about 400 normal skull x rays being undertaken in period 2. The percentage of children undergoing CT rose from 1.0% to 2.1% with no change in the positive CT pick up rate (25.6% v 25.0%). There was no significant change in admission rate (10.9% v 10.1%), and a slight decrease in the radiation dose per head injury (0.042 mSv compared to 0.045 mSv). Conclusions: Skull x rays can be abandoned in children aged 1 to 14 without a significant increase in admission rate, radiation dose per head injury, or missed intracranial injury. The mechanism and history of the injury and a reduced Glasgow coma scale are probably the most important indicators of significant head injury in children.