Don’t perform routine radiology of the skull in minor head injury.

Type of practice


Topic Area

Medical Radiology

Minor traumatic brain injury (TBI) is defined as a head injury with or without a history of loss of consciousness, amnesia or confusion, with a Glasgow Coma Score (GCS) of 14 or 15; excluding patients with focal neurological deficit, suspected sunk fracture or with clinical signs of basilar skull fracture. X-ray of the skull can identify fractures associated with an increased intracranial bleeding risk, but does not identify the intracranial bleeding. Therefore it is not routinely indicated in minor TBI, while Computed Tomography (CT) is considered the reference examination to detect lesions of immediate clinical importance. Performing inappropriate skull radiography in head trauma can delay the execution of CT or other urgent tests and exposes the patient to ionizing radiations unnecessarily. Despite the demonstrated not usefulness of those examinations, many skull radiographs continue to be requested. A GCS score of 15 (patient fully conscious), absence of risk factors and no symptoms except pain at the point of impact, contraindicate even the immediate execution of CT.


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