Abstract
OBJECTIVE: To audit the appropriateness of skill radiography in children attending an accident and emergency (A&E) department with head injuries. METHODS: 569 children presenting to a large teaching hospital A&E unit were retrospectively audited. The indications for radiography according to British published guidelines and American published guidelines were compared with the actual requests for radiography. The criteria for admission from the two guidelines were also compared with the actual admissions. RESULTS: 50% of children presenting with head injury actually had skull radiography. If British guidelines for the use of skull radiography had been complied with, 63% of children should have had radiography, but if American guidelines had been used, 18% would have required radiography. All the actual fractures identified were in this 18%. CONCLUSIONS: The British guidelines overinvestigate children with head injury. This seems to have been recognised clinically, and the doctors did not adhere to the guidelines. Neither did they adhere to the American guidelines, which would have resulted in a further reduction in radiography. All the fractures identified were covered by the American guidelines. The American guidelines for skull radiography can be safely used in a British A&E unit.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Boulis Z. F., Dick R., Barnes N. R. Head injuries in children--aetiology, symptoms, physical findings and x-ray wastage. Br J Radiol. 1978 Nov;51(611):851–854. doi: 10.1259/0007-1285-51-611-851. [DOI] [PubMed] [Google Scholar]
- Brookes M., MacMillan R., Cully S., Anderson E., Murray S., Mendelow A. D., Jennett B. Head injuries in accident and emergency departments. How different are children from adults? J Epidemiol Community Health. 1990 Jun;44(2):147–151. doi: 10.1136/jech.44.2.147. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Clarke J. A., Adams J. E. The application of clinical guidelines for skull radiography in the Accident and Emergency department: theory and practice. Clin Radiol. 1990 Mar;41(3):152–155. doi: 10.1016/s0009-9260(05)80957-2. [DOI] [PubMed] [Google Scholar]
- Guidelines for initial management after head injury in adults. Suggestions from a group of neurosurgeons. Br Med J (Clin Res Ed) 1984 Mar 31;288(6422):983–985. doi: 10.1136/bmj.288.6422.983. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Masters S. J., McClean P. M., Arcarese J. S., Brown R. F., Campbell J. A., Freed H. A., Hess G. H., Hoff J. T., Kobrine A., Koziol D. F. Skull x-ray examinations after head trauma. Recommendations by a multidisciplinary panel and validation study. N Engl J Med. 1987 Jan 8;316(2):84–91. doi: 10.1056/NEJM198701083160205. [DOI] [PubMed] [Google Scholar]
- McNally E., de Lacey G., Lovell P., Welch T. Posters for accident departments: simple method of sustaining reduction in x ray examinations. BMJ. 1995 Mar 11;310(6980):640–642. doi: 10.1136/bmj.310.6980.640. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Teasdale G. M., Murray G., Anderson E., Mendelow A. D., MacMillan R., Jennett B., Brookes M. Risks of acute traumatic intracranial haematoma in children and adults: implications for managing head injuries. BMJ. 1990 Feb 10;300(6721):363–367. doi: 10.1136/bmj.300.6721.363. [DOI] [PMC free article] [PubMed] [Google Scholar]