Value of radiological diagnosis of skull fracture in the management of mild head injury: meta-analysis
P A M Hofmana, P Nelemansb, G J Kemerinka, J T Wilminka
a Department of
Radiology, University Hospital Maastricht and the University
Maastricht, PO Box 5800, 6200 AZ, Maastricht, The Netherlands, b Department of Epidemiology
Correspondence to: Dr P A M Hofman, Department of Radiology, University Hospital Maastricht, PO Box 5800, 6200 AZ, Maastricht, The Netherlands email pho{at}rdia.azm.nl
Received 26 April 1999 and in revised form 21 October 1999;
Accepted 29 October
1999
OBJECTIVES
Head injury
is a common event. Most patients sustain a mild head injury (MHI), and
management depends on the risk of an intracranial haemorrhage (ICH).
The value of a plain skull radiograph as a screening tool for ICH is
controversial. The aim of this meta-analysis was to estimate and
explain differences in reported sensitivity and specificity of the
finding of a skull fracture for the diagnosis of ICH, in order to
assess the value of the plain skull radiograph in the investigation of
patients with MHI, and to estimate the prevalence of ICH in these patients.
METHODAfter a
systematic literature search 20 studies were selected that reported
data on the prevalence of ICH after MHI and/ or data on the diagnostic
value of skull fracture for the diagnosis of ICH. The mean prevalence
of ICH weighted for the sample size was determined. The sensitivity and
specificity of different studies were combined using a summary receiver
operator characteristic curve. Correlation analysis was used to
determine factors that could explain the reported differences between studies.
RESULTSThe weighted
mean prevalence of ICH after MHI is 0.083. The potential for
verification bias and the percentage of patients who had suffered loss
of consciousness or post-traumatic amnesia were the most significant
factors explaining interstudy differences in sensitivity and
specificity. Based on studies wherein at least 50% of patients had a
CT study of the brain, the estimated sensitivity of a radiographic
finding of skull fracture for the diagnosis of ICH is 0.38 with a
corresponding specificity of 0.95.
CONCLUSIONThe plain
skull radiograph is of little value in the initial assessment of MHI patients.
Keywords: head injury; skull fracture; meta-analysis; radiological diognosis
© 2000 by Journal of Neurology, Neurosurgery, and Psychiatry
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Relevant Article
- Skull fractures and mild head injury
- IVAN MOSELEY
J. Neurol. Neurosurg. Psychiatry 2000 68: 403-404.[Extract] [Full Text]
This article has been cited by other articles:
-
Smits, M, Hunink, M G M, Nederkoorn, P J, Dekker, H M, Vos, P E, Kool, D R, Hofman, P A M, Twijnstra, A, de Haan, G G, Tanghe, H L J, Dippel, D W J
(2007). A history of loss of consciousness or post-traumatic amnesia in minor head injury: "conditio sine qua non" or one of the risk factors?. J. Neurol. Neurosurg. Psychiatry
78: 1359-1364
[Abstract] [Full Text] -
Ropper, A. H., Gorson, K. C.
(2007). Concussion. NEJM
356: 166-172
[Full Text] -
Smits, M., Dippel, D. W. J., de Haan, G. G., Dekker, H. M., Vos, P. E., Kool, D. R., Nederkoorn, P. J., Hofman, P. A. M., Twijnstra, A., Tanghe, H. L. J., Hunink, M. G. M.
(2005). External Validation of the Canadian CT Head Rule and the New Orleans Criteria for CT Scanning in Patients With Minor Head Injury. JAMA
294: 1519-1525
[Abstract] [Full Text] -
Dunning, J, Lecky, F
(2004). The NICE guidelines in the real world: a practical perspective. Emerg. Med. J.
21: 404-407
[Abstract] [Full Text] -
Benham, J, Chavda, S.
(2004). Head trauma. Trauma
6: 101-110
[Abstract] -
Hofman, P. A.M., Verhey, F. R.J., Wilmink, J. T., Rozendaal, N., Jolles, J.
(2002). Brain Lesions in Patients Visiting a Memory Clinic With Postconcussional Sequelae After Mild to Moderate Brain Injury. J. Neuropsychiatry Clin. Neurosi.
14: 176-184
[Abstract] [Full Text] -
Hofman, P. A.M., Stapert, S. Z., van Kroonenburgh, M. J.P.G., Jolles, J., de Kruijk, J., Wilmink, J. T.
(2001). MR Imaging, Single-photon Emission CT, and Neurocognitive Performance after Mild Traumatic Brain Injury. Am. J. Neuroradiol.
22: 441-449
[Abstract] [Full Text] -
MOSELEY, I.
(2000). Skull fractures and mild head injury. J. Neurol. Neurosurg. Psychiatry
68: 403-404
[Full Text]
- Full Text
- Full Text (PDF)
- Submit a response
- Alert me when this article is cited
- Alert me when eLetters are posted
- Alert me if a correction is posted
- Citation Map
Services
- Email this link to a friend
- Similar articles in this journal
- Similar articles in PubMed
- Add article to my folders
- Download to citation manager
- Request Permissions
Citing Articles
Google Scholar
PubMed
Topic Collections
-
Memory disorders (neurology)
-
Neurological injury
-
Trauma CNS / PNS
-
Memory disorders (psychiatry)
-
Radiology
- Relevant Article
Bookmark with
Register for free content
The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.
Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.
