Head injuries in children--aetiology, symptoms, physical findings and x-ray wastage

Abstract

One thousand and thirty-two consecutive children with head injuries have been studied. All were outpatients, and 1000 had X-rays requested and performed. Of those X-rayed, only 21 (2.1%) had fractures, whilst 129 cases (12.9%) required admission for observation. No patient developed complications from their injuries. The presence or absence of a fracture neither correlated with the clinical situation nor affected the management. The fact that two thirds of all new casualty attendances at UK hospitals have an X-ray examination (British Medical Journal, 1977) is an unjustified wastage. Much of this wastage is related to skull X-rays in trauma, especially in children. In only a minority of patients does the presence of a fracture result in any modification of treatment. Some suggestions as to indications for skull X-rays in trauma have been made to help select patients for radiography and to avert wastage.