A study on plain X-ray skull imaging in the public Primary Health Care Department in Malta

Abstract

Background In January 2014, the National Institute for Health and Clinical Excellence (NICE) published the guideline [CG176]: Head injury: assessment and early management. These guidelines advise that plain X-rays of the skull should not be used to diagnose significant brain injury without prior discussion with a neuroscience unit. However, they are useful as part of a skeletal survey for suspected non-accidental injury in children. Objectives Our study was conducted to quantify the skull X-rays performed over a period of 12 months and review whether the cases adhere to the NICE guideline [CG176]: Head injury: assessment and early management. Method A descriptive, retrospective, cross-sectional study design was applied. Data was obtained from the Radiology Information System (RIS) and the Picture Archiving and Communication System (PACS). The Statistical Package for Social Sciences Version 20 was used in the data analysis. Results There were 127 skull X-rays performed in primary health care centres in 2016. The majority of patients were males (56%, n = 71). There were 83 (65.4%) skull X-rays requested for cases of trauma or queries about fractures. Around 3% of requests (n = 4) were made to exclude foreign bodies. Conclusion After reaching the study objectives, it was noted that there is a need to increase awareness of the NICE guidelines to improve the use of skull radiography thus ensuring more efficient resource utilisation.