High-yield referral criteria for posttraumatic skull roentgenography. Response of physicians and accuracy of criteria

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Abstract
A list of high-yield criteria (HYL) was evaluated as a means of reducing posttraumatic skull roentgenograms and as a diagnostic test for skull fractures. Physicians requested roentgenograms for 76.9% of head trauma patients in a 4 mo. control period, but for only 46.1% during a 4 mo. experimental period, a relative decrease of 40%. When the experiment ended, roentgenogram use increased to 72% of head trauma patients. HYL accurately classified 92.5% of the patients with and 84.5% of the patients without pathological conditions. HYL displayed substantial differences in sensitivity and specificity from HYL used previously. Clinicians disliked the HYL, beliving it was inaccurate and a monitoring device. Criteria lists can effectively decrease requests for roentgenograms and should be carefully evaluated as diagnostic tests for accuracy and adverse outcomes.

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