Retrospective review of traumatic brain injury: is skull X-ray still clinically relevant?
By: Anze Lecnik, Ziga Samsa, Borut Hribernik and Janez Ravnik
References
- Jha S, Ghewade P. Management and treatment of traumatic brain injuries. Cureus 2022; 14: e30617. doi: 10.7759/cureus.30617
- Alshafai N, Maas AIR. Epidemiology of head injury and outcome after head injury. In: Kirollos RW, Helmy A, Thomson S, Hutchinson PJA, editors. Oxford textbook of neurological surgery. Oxford: Oxford University Press; 2019. p. 475–81.
- Brazinova A, Rehorcikova V, Taylor MS, Buckova V, Majdan M, Psota M, et al. Epidemiology of traumatic brain injury in Europe: a living systematic review. J Neurotrauma 2021; 38: 1411–40. doi: 10.1089/neu.2015.4126
- Wintermark M, Sanelli PC, Anzai Y, Tsiouris AJ, Whitlow CT. Imaging evidence and recommendations for traumatic brain injury: conventional neuroimaging techniques. J Am Coll Radiol 2015; 12: e1–14. doi: 10.1016/j.jacr.2014.10.003
- Schweitzer AD, Niogi SN, Whitlow CT, Tsiouris AJ. Traumatic brain injury: imaging patterns and complications. Radiographics 2019; 39: 1571–95. doi: 10.1148/rg.2019190076
- National Institute for Health and Care Excellence. Head injury: assessment and early management. NICE guideline NG232 [Internet]. London: NICE; 2023. [cited 2026 Mar 15]. Available at:
https://www.nice.org.uk/guidance/ng232 - Undén J, Ingebrigtsen T, Romner B; Scandinavian Neurotrauma Committee. Scandinavian guidelines for initial management of minimal, mild and moderate head injuries in adults: an evidence and consensus-based update. BMC Med 2013; 11: 50. doi: 10.1186/1741-7015-11-50
- American College of Radiology. ACR appropriateness criteria: head trauma. 2021 update [Internet]. Reston (VA): American College of Radiology; 2021. [cited 2026 Mar 16]. Available at:
https://acsearch.acr.org/docs/69481/Narrative/ - Lumba-Brown A, Yeates KO, Sarmiento K, Breiding MJ, Haegerich TM, Gioia GA, et al. Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children. JAMA Pediatr 2018; 172: e182853. doi: 10.1001/jamapediatrics.2018.2853
- Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet 2001; 357: 1391–6. doi: 10.1016/S0140-6736(00)04561-X
- Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med 2000; 343: 100–5. doi: 10.1056/NEJM200007133430204
- Mower WR, Hoffman JR, Herbert M, Wolfson AB, Pollack CV Jr, Zucker MI; NEXUS II Investigators. Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. J Trauma 2005; 59: 954–9. doi: 10.1097/01.ta.0000187813.79047.42
- McClean PM, Joseph LP, Rudolph H. Skull film radiography in the management of head trauma. Ann Emerg Med 1984; 13: 607–11. doi: 10.1016/s0196-0644(84)80287-5
- Chan KH, Mann KS, Yue CP. The significance of skull fracture in acute traumatic intracranial hematomas in adolescents: a prospective study. J Neurosurg 1990; 72: 189–94. doi: 10.3171/jns.1990.72.2.0189
- Hofman PA, Nelemans P, Kemerink GJ, Wilmink JT. Value of radiological diagnosis of skull fracture in the management of mild head injury: meta-analysis. J Neurol Neurosurg Psychiatry 2000; 68: 416–22. doi: 10.1136/jnnp.68.4.416
- Nekuda V, Krtička M, Miklošová B, Švancara J, Chovanec M. [Importance of skull X-ray in head trauma]. [Czech]. Acta Chir Orthop Traumatol Cech 2019; 86: 342–7. doi: 10.55095/achot2019/058
- Chawla H, Malhotra R, Yadav RK, Griwan MS, Paliwal PK, Aggarwal AD. Diagnostic utility of conventional radiography in head injury. J Clin Diagn Res 2015; 9: TC13–5. doi: 10.7860/JCDR/2015/13842.6133
- Alzuhairy AKA. Accuracy of Canadian CT Head Rule and New Orleans Criteria for minor head trauma: a systematic review and meta-analysis. Arch Acad Emerg Med 2020; 8: e79. PMID: 33244515
- Dunning J, Batchelor J, Stratford-Smith P, Teece S, Browne J, Sharpin C, et al. A meta-analysis of variables that predict significant intracranial injury in minor head trauma. Arch Dis Child 2004; 89: 653–9. doi: 10.1136/adc.2003.027722
- Andronikou S, Kilborn T, Patel M, Fieggen AG. Skull fracture as a herald of intracranial abnormality in children with mild head injury: is there a role for skull radiographs? Australas Radiol 2003; 47: 381–5. doi: 10.1046/j.1440-1673.2003.01206.x
- Moreea S, Jones S, Zoltie N. Radiography for head trauma in children: what guidelines should we use? J Accid Emerg Med 1997; 14: 13–5. doi: 10.1136/emj.14.1.13
- Masters SJ, McClean PM, Arcarese JS, Brown RF, Campbell JA, Freed HA, et al. Skull X-ray examinations after head trauma. Recommendations by a multidisciplinary panel and validation study. N Engl J Med 1987; 316: 84–91. doi: 10.1056/NEJM198701083160205
- Chung S, Schamban N, Wypij D, Cleveland R, Schutzman SA. Skull radiograph interpretation of children younger than two years: how good are pediatric emergency physicians? Ann Emerg Med 2004; 43: 718–22. doi: 10.1016/j.annemergmed.2003.09.020
Language: English
Submitted on: May 20, 2026
Accepted on: Aug 10, 2026
Published on: Oct 22, 2026
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
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© 2026 Anze Lecnik, Ziga Samsa, Borut Hribernik, Janez Ravnik, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.