Results of this study suggest that skull X-ray may be redundant during nonaccidental injury (NAI) workup that includes diagnostic-quality head CT.
Why this matters
- A 2008 standard from the Royal Colleges of Radiologists and of Paediatrics and Child Health recommended skull X-rays plus head CT in NAI workups; authors note recommendation was based on older research.
- Volumetric imaging via helical CT has largely superseded older step-and-shoot individual image technique.
- CT detected 17 cases of intracranial pathology (18%), including 13 skull fractures, 2 not detected on skull X-rays.
- No skull radiograph detected intracranial pathology.
- Researchers calculated it is 95% certain that the rate of findings visible on X-ray, but not CT, is <3.9%.
- Literature review, retrospective cohort study, 94 patients aged 24 days to 23 months presenting with possible NAI to a British emergency department.
- All patients had both skull X-rays and noncontrast head CT.
- Outcome: proportion of injuries on skull X-ray and not CT.
- Funding: None.
- Small study, single tertiary center with pediatric radiologists.
- More research needed to confidently eliminate skull CT.
- Royal Colleges 2017 recommendations replaced 2008 edition; they still call for skeletal survey (which includes skull X-ray) plus head CT.