BMJ 1995;311:329-330 (29 July)

Letters

Radiology guidelines could be improved

EDITOR,--Radiologists' suggestions to help reduce unnecessary x ray examinations in patients prescribing to accident and emergency departments have been welcome. Eugene McNally and colleagues suggest that this reduction can be sustained by the use of posters.1 I am concerned, however, about the content of the two examples of their posters shown in their paper.

The poster illustrating the guidelines for x ray examination of the skull states, "Do not x-ray patients who are to be admitted." A linear fracture is important chiefly as an indicator of potential secondary intracranial bleeding.2 A patient with a head injury who is not oriented will be admitted for observation. If this patient has no skull fracture there is a 1 in 100 risk of a serious intracranial bleed. That risk is increased 25 times to 1 in 4 if a skull fracture is present.3

Reducing the threshold for performing computed tomography is one answer, . . . [Full text of this article]


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Relevant Article

Recent Advances: Posters for accident departments: simple method of sustaining reduction in x ray examinations
Eugene McNally, Gerald de Lacey, Philippa Lovell, and Theo Welch
BMJ 1995 310: 640-642. [Abstract] [Full Text]

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