A review of the practice of requesting skull x-rays from the Emergency Department of St Luke’s Hospital

Abstract

Background: In the Emergency Department (ED) of St. Luke's Hospital (SLH), head injuries are a common presentation. Although there are various guidelines which recommend approaches to the management of head injuries, these are not followed locally and the authors feel that a significant number of unnecessary skull x-rays (SXR) are being ordered by doctors. In this review we wished to observe the current trends in head injury investigations at the SLH ED and compare these with the NICE head injury guidelines. We also wanted to determine the impact that the NICE guidelines would have on these trends if they were to be instituted. Methods: The study is retrospective and observational. The demographics together with the rates of SXRs, CT scans and admissions were determined for patients presenting with head injury between the 1st of February and the 31st March 2006. The study also looked at the predicted rates had NICE guidelines been applied. Results: 387 patients were studied in a 2 month period. Of this total, only 2 patients (0.5%) had indications for a SXR but 312 patients (80.6 %) had this investigation. Out of this total of SXRs only 6 had positive findings (1.9%) and these went on to have a CT brain. A total of 72 patients had a CT scan of the head and of these 10 (13.9%) had positive findings. According to NICE guidelines 70 patients had indications for a CT. One hundred and twenty one patients (31.3%) were admitted, 201 were discharged (51.9%) and 65 patients (16.8%) discharged themselves against medical advice. Conclusion: The implementation of NICE guidelines would greatly reduce the rates of SXRs and hence reduce costs and radiation exposure. It also seems that the rates of CT scans will not change significantly.