The Utility and Futility of Radiographic Skull Examination for Trauma

Increasing use of x-ray evaluation of head injury adds to the cost of medical care, but produces diminishing yields of useful information. Classification of 1500 patients on the basis of preliminary clinical examination resulted in their assignment to high-yield groups (92 fractures in 1065 radiographic examinations) or low-yield groups (one fracture in 435 radiographic examinations). X-ray examination in the latter group could have been deferred or omitted without adverse effect on the patient's medical care. Such a strategy applied on a national scale potentially could result in a yearly saving of $15,000,000 in health-care cost.