SKULL X-RAY AFTER HEAD-INJURY - THE RECOMMENDATIONS OF THE ROYAL-COLLEGE-OF-SURGEONS WORKING PARTY REPORT IN PRACTICE

In 1986 a Royal College of Surgeons Working Party published guidelines , based on over 15 years of clinical research both here and in the U.S .A., on when to perform skull X-rays on a head injury patient. In this retrospective study the recorded details of 405 patients who presente d to an accident and emergency (A&E) department over a 3-month period in 1991 are analysed, and the Report criteria applied to each one to a ssess whether the guidelines are being followed in performing a skull X-ray. According to these guidelines, 191 of these patients (47.2%) sh ould have been X-rayed, however, only 83 were. Only one patient was th ought to have been X-rayed inappropriately. The Report criteria most c ommonly thought by the A&E doctors not to warrant skull X-ray, were lo ss of consciousness, amnesia, dizziness, blurred vision, headache, and alcohol intoxication. The reasons why these criteria are being ignore d are examined, and together with reference to recent studies, slight alterations to the Working Party guidelines are suggested to make them more applicable to everyday clinical situations of head injury encoun tered in a casualty department.