Implementation of guidelines for the use of skull radiographs in patients with head injuries.

Guidelines formulated by the Royal College of Radiologists' Working Party on the Effective Use of Diagnostic Radiology were introduced into an accident-and-emergency department to determine their effect on the use of skull radiographs in patients with head injuries and on the number of admissions for observation. After approval by senior staff and substitution of the routine casualty record with a head-injury casualty card, the guidelines were distributed throughout the department, and seminars on the suggested use of skull radiographs were held for junior medical staff. The proportion of new accident-and-emergency attenders having skull radiographs fell by 51%. The average number of skull examinations carried out in the department decreased from 373 to 189 per month, but there was no increase in the number of patients with head injuries admitted for observation.