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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.
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