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

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Abstract
Children with head injuries were studied. All (1032) were outpatients, and 1000 had X-rays requested and performed. Of those X-rayed, only 21 (2.1%) had fractures, while 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 2/3 of all new casualty attendances at UK hospitals had 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 helped in selecting patients for radiography and to avert wastage.

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