SELECTIVE INDICATIONS FOR SKULL X-RAYS AF TER HEAD TRAUMATISM OF THE CHILD

Purpose of the study Skull X-rays are systematically performed on chil dren after head injuries in most hospitals. However, the discovery of a skull fracture as an isolated finding rarely warrants intervention. In february 1994, we stopped performing systematical skull X-rays in c hildren after head injuries. We report the results of this experience. Materials and methods Since February 1994, only children with possibl e skull penetration, depressed fracture, or presenting signs of basila r fracture had X-ray examination. Facial injuries were excluded in thi s study. In case of focal neurologic signs, neurosurgical consultation , or emergency CT examination, or both were performed. In case of chan ge of consciousness at the time of injury or subsequently, the child w as hospitalised for clinical observation for 48 hours, but no X-ray ex amination was performed. Children without any neurological signs or ch ange of consciousness were discharged to their homes after they were g iven a head-injury instruction sheet, and if a second person could obs erve them for signs indicating that they belung to a higher risk group , but no X-ray examination was performed. Results An average of 241 ch ildren per month were presented at the Children Emergency Unit after h ead trauma. An average of twenty-one X-ray examinations per month were performed instead of 194/month before february 1994. This represented a decrease of 2000 X-ray examinations per year. There was no undiagno sed neurological complication, and the number of children staying in t he hospital for clinical supervision did not increase. Discussion Skul l radiographies only show fractures and do not afford visibility of ei ther brain or blood to demonstrate an intracranial injury. The presenc e of a skull fracture without neurological abnormalities is of little significance. Harwood-Nash reported that 60 per cent of the children w ith extradural hematoma, 85 per cent of the children with subdural hem atoma and 35 per cent of the children with brain damage did not have a ny associated skull fracture. Clinical examination is essential, and i t would be a mistake to be reassured about the severity of a head trau ma because skull X-rays are normal. Conclusion Routine skull X-rays af ter head trauma are not justified either for financial or radioprotect ion reasons. In this study, more than half of the children were less t han five years old and ran a higher risk of irradiation.