CT scans of skull to find non-accidental injuries make x-rays 'redundant'

Current standards from the Royal College of Radiologists and the Royal College of Pediatrics and Child Health in the United Kingdom state that skull x-rays should be performed alongside a CT brain scan amid suspicion of non-accidental injury (NAI). 

However, according to researchers from the Alder Hey Children's NHS Foundation Trust in Liverpool, England, a volumetric CT head exam may be enough to identify NAI without an additional x-ray. Their study was recently published online on March 1 in the journal Clinical Radiology. 

"Skull x-rays could be excluded from the non-accidental injury skeletal survey without missing intracranial injuries or skull fractures in cases where a contemporaneous volumetric CT head is also performed," wrote lead author R.E. Brown, MD.  

A total of 94 infants aged between 24 days and 23 months were identified from local radiology system records for the study. All participants were brought to the ED between August 2014 to July 2016 and had checkups for suspected NAI. Researchers identified qualifying participants based on if they had both unenhanced volume CT head and skull radiography during checkups. 

According to study results, skull x-rays of all 94 participants showed no additional findings after the CT exams.   

"Due to the starkness of this result, the confidence interval is zero to 3.9 percent," the researchers concluded.  "In two cases, additional bony findings were demonstrated on the CT head which were not evident on the skull x-rays,"