J Korean Radiol Soc.  1992 Oct;28(5):651-657.

Evaluation of the efficacy of simple skull examination in head trauma

• Lee WJ
• Lee SH
• Lee SW
• Park SS
• Lee YC
• Kim KS

Abstract

In evaluation of head trauma, simple skull examinations have been almost routinely requested in emergency room, regardless of historical, physical or neurologic findings, for fear of an unexpected fracture and medicolegal problem. Considering the low yield rate of positive radiologic findings for skull fracture and poor correlation of skull fracture with intracranial sequelae, simple skull examinations in head trauma patients, especially in those with minor trauma, is overutilized without reasonable clinical criteria of application. A retrospective review of 1,101 patients was performed to evaluate the efficacy of simple skull examination at the point of diagnosis and treatment, and to predict the risk for skull fracture and significant intracranial sequelae by clinical findings. Eighty-six patients(7.8%) had skull fractures including two basilar fractures and 12 depressed fractures. 116 patients(10.5%) had significant intracranial sequelae and 62 of these had skull fractures. Of 1,101 patients, 237 had the clinical findings of "high-yield" features and 70 of these had skull fractures and 99 had intracranial sequelae, so high-yield fractures are very indicative for the skull fracture and intracramal sequelae. Only in nine patients(0.08%0 the managements were altered after simple skull examination in that two with basilar fractures were treated with antibiotics and seven with depressed fractures were undergone neurosurgical precedures. Patients who were not admitted nor required further study or treatment because of minor head traumadidn't have any skull fractures or intracranial sequelae in our series, and 62 of 116 patients with intracranial sequelae showed normal skull findings indicating that normal findings can create false sense of security.

MeSH Terms

Anti-Bacterial Agents
Craniocerebral Trauma*
Diagnosis
Emergency Service, Hospital
Head*
Humans
Neurologic Manifestations
Retrospective Studies
Skull Fractures
Skull*
Anti-Bacterial Agents