Skip to main content
NCBI home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2005 Apr 25;90(8):859–864. doi: 10.1136/adc.2004.053603

Can we abolish skull x rays for head injury?

M Reed 1, J Browning 1, A Wilkinson 1, T Beattie 1
PMCID: PMC1720521  PMID: 15851418

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.

Full Text

The Full Text of this article is available as a PDF (85.7 KB).

Figure 1.

Figure 1

Open in a new tab

 Distribution of head injuries by age.

Figure 2.

Figure 2

Open in a new tab

 (A) Patient flow chart 1998–1999. (B) Patient flow chart 2002–2003.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brown F. D., Brown J., Beattie T. F. Why do children vomit after minor head injury? J Accid Emerg Med. 2000 Jul;17(4):268–271. doi: 10.1136/emj.17.4.268. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Jennett B. Epidemiology of head injury. J Neurol Neurosurg Psychiatry. 1996 Apr;60(4):362–369. doi: 10.1136/jnnp.60.4.362. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Jennett B. Epidemiology of head injury. Arch Dis Child. 1998 May;78(5):403–406. doi: 10.1136/adc.78.5.403. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Jennett B., MacMillan R. Epidemiology of head injury. Br Med J (Clin Res Ed) 1981 Jan 10;282(6258):101–104. doi: 10.1136/bmj.282.6258.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Lloyd D. A., Carty H., Patterson M., Butcher C. K., Roe D. Predictive value of skull radiography for intracranial injury in children with blunt head injury. Lancet. 1997 Mar 22;349(9055):821–824. doi: 10.1016/S0140-6736(96)09356-7. [DOI] [PubMed] [Google Scholar]
  6. Macgregor D. M. Golf related head injuries in children. Emerg Med J. 2002 Nov;19(6):576–577. doi: 10.1136/emj.19.6.576. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Mendelow A. D., Teasdale G., Jennett B., Bryden J., Hessett C., Murray G. Risks of intracranial haematoma in head injured adults. Br Med J (Clin Res Ed) 1983 Oct 22;287(6400):1173–1176. doi: 10.1136/bmj.287.6400.1173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Palchak Michael J., Holmes James F., Vance Cheryl W., Gelber Rebecca E., Schauer Bobbie A., Harrison Mathew J., Willis-Shore Jason, Wootton-Gorges Sandra L., Derlet Robert W., Kuppermann Nathan. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med. 2003 Oct;42(4):492–506. doi: 10.1067/s0196-0644(03)00425-6. [DOI] [PubMed] [Google Scholar]
  9. Sainsbury C. P., Sibert J. R. How long do we need to observe head injuries in hospital? Arch Dis Child. 1984 Sep;59(9):856–859. doi: 10.1136/adc.59.9.856. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Sharples P. M., Storey A., Aynsley-Green A., Eyre J. A. Avoidable factors contributing to death of children with head injury. BMJ. 1990 Jan 13;300(6717):87–91. doi: 10.1136/bmj.300.6717.87. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Strang I., MacMillan R., Jennett B. Head injuries in accident and emergency departments at Scottish hospitals. Injury. 1978 Nov;10(2):154–159. doi: 10.1016/s0020-1383(79)80084-4. [DOI] [PubMed] [Google Scholar]
  12. 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]
  13. Wall B. F., Hart D. Revised radiation doses for typical X-ray examinations. Report on a recent review of doses to patients from medical X-ray examinations in the UK by NRPB. National Radiological Protection Board. Br J Radiol. 1997 May;70(833):437–439. doi: 10.1259/bjr.70.833.9227222. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES