A comparison of two or three radiographic views in the diagnosis of skull fractures.
ABSTRACT The aim of the study is to determine whether a two rather than a three-view skull series is adequate for diagnosis of a skull fracture given a reliable history of the site of trauma. The radiographs of 50 patients who were diagnosed and managed as having sustained skull fractures were randomly mixed with 200 normal skull series and viewed independently by three observers. For all the film series viewed (a total of 1500 for the three observers), the diagnostic confidence level for two films was 94.4%, and for three films 94.6%. Of a total of 150 skull fracture series viewed as two films, 87 (58%) were correctly diagnosed with a confidence level of 92.7%. When viewed as three films, 92 (61.3%) were correctly diagnosed with a confidence level of 93%. Combined with analysis of false-positive and false-negative results, no statistical difference could be detected between a two or three film skull series. A two-view skull series has no statistically deleterious effect on either diagnostic accuracy or confidence of interpretation when compared with a three-view series given an accurate clinical history.
- SourceAvailable from: nih.govBritish medical journal 07/1976; 1(6022):1383-5.
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ABSTRACT: The frequency and significance of skull fracture after both mild and severe injuries are discussed by reference to large series of patients. Important management decisions depend on the finding or exclusion of a fracture. Inadequate treatment of an open injury frequently results in intracranial infection, and this is most often due to failure to take a skull X-ray, but sometimes the result of missing the fracture on the film. Failure to detect a linear fracture of the vault is a common reason for delayed diagnosis of intracranial haematoma, with resultant mortality and morbidity. Inability reliably to exclude a skull fracture in accident and emergency departments results in thousands of unnecessary admissions to hospital in Britain, causing inconvenience to patients and wasteful use of Health Service resources. Detection of fracture is also important in selecting patients for CT scanning, which can be made available only to a minority of patients. Skull films taken in accident and emergency departments are sometimes of poor quality and this is more often due to poor technique than to lack of co-operation by the patient. Not only is there need to improve technical standards of skull radiography in these departments, but clinicians there should be trained by radiologists to interpret the skull films, and to recognise when these are not of diagnostic quality. This need for more and better skull X-rays stems from the demands of good clinical practice rather than medicolegal considerations.Clinical Radiology 08/1980; 31(4):463-9. · 1.82 Impact Factor
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ABSTRACT: The features of 3500 patients with head injury who attended accident and emergency departments in Scotland during 1974 are described. These represented 10 per cent of all attenders at these departments. Recent alcohol consumption was noted in 25 per cent of adult males; this was commonest amongst those who were victims of assault or pedestrians involved in traffic accidents. Forty-one per cent of patients had scalp wounds; 58 per cent had radiographs of the skull taken and of these 2.7 per cent had fractures of the skull. Although 20 per cent of patients had altered consciousness at some time, only 5 per cent showed any evidence of impaired consciousness when seen at hospital. Twenty-three per cent of those attending were admitted to hospital. Criteria which are important when assessing whether a head-injured patient should be admitted to hospital are listed.Injury 12/1978; 10(2):154-9. · 1.93 Impact Factor