Radiographic diagnosis of head trauma

We evaluated the necessity of skull plain radiography in comparison with computed tomography (CT) in 677 cases of head trauma, according to the Masters' criteria which devided patients into three groups. Fractures detected by plain radiography in low, moderate, and high-risk group were 1 %, 11 %, and 44 %, respectively. Abnormalities in each risk group were detected by CT in 0 %, 26 %, and 74 % of the cases, respectively. In the low-risk group, head injuries are very trivial. Fractures are very rare and, if present, they are linear and not associated with intracranial injuries. The detection of a linear fracture itself is not important in the management of patients. The Radiologic imaging is not recommended and plain radiography should be omitted. In the moderate-risk group, the patients who meet more than two moderate-risk criteria should be examined by CT immediately. For the patients who meet only one moderate-risk criteria, extended close observation is essential and CT should be considered if necessary. In the high-risk group, the most sterious intracranial injuries are clinically obvious. Emergency CT and neurosurgical consultation are indicated. We conclude that CT can reveal all essential findings, such as intracranial injuries, basal and depressed fractures, which determine the management and the prognosis. Plain radiography is no longer necessary in most cases and should be performed after CT in a few selected cases. (author)