Skull X-rays after recent head injury

Abstract

The frequency and significance of skull fracture after both mild and severe injuries are discussed by reference to large series of patients. Important management decisions depend on the finding or exclusion of a fracture. Inadequate treatment of an open injury frequently results in intracranial infection, and this is most often due to failure to take a skull X-ray, but sometimes the result of missing the fracture on the film. Failure to detect a linear fracture of the vault is a common reason for delayed diagnosis of intracranial haematoma, with resultant mortality and morbidity. Inability reliably to exclude a skull fracture in accident and emergency departments results in thousands of unnecessary admissions to hospital in Britain, causing inconvenience to patients and wasteful use of Health Service resources. Detection of fracture is also important in selecting patients for CT scanning, which can be made available only to a minority of patients. Skull films taken in accident and emergency departments are sometimes of poor quality and this is more often due to poor technique than to lack of co-operation by the patient. Not only is there need to improve technical standards of skull radiography in these departments, but clinicians there should be trained by radiologists to interpret the skull films, and to recognise when these are not of diagnostic quality. This need for more and better skull X-rays stems from the demands of good clinical practice rather than medicolegal considerations.