Patient selection for skull radiography in uncomplicated head injury.

The costs and benefits of six different patient-selection guidelines for skull radiography are presented. The study is based on data from a national study involving 4829 patients with uncomplicated head injury who underwent skull radiography in nine accident and emergency units throughout the U.K. With the most conservative guideline 94% of patients with vault fractures and all those in whom outcome was serious (depressed, basal, or frontal fracture, intracranial haematoma, aerocele, or death) would be X-rayed, at a saving of 21 . 3% on radiological costs incurred by current practice. At the other extreme is a guideline which embraced 58 . 2% of patients with vault fractures and 85% of patients with serious outcome, at a saving of 72 . 9%. The range of guidelines permits the reader to explore his own preference and become aware of the implications of his choice.