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Tangential views or computed tomography in suspected depressed skull fracture
  1. Magnus Harrison, Specialist Registrar,
  2. Steve Jones, Specialist Registrar

    Abstract

    A short cut review was carried out to establish whether CT scans are better than tangential skull radiographs at detecting depressed skull fractures. No papers answering this question were found using the reported search.

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    Report by Magnus Harrison,Specialist RegistrarSearch checked by Steve Jones, Specialist Registrar

    Clinical scenario

    A 35 year old man alleges that he has been assaulted. He claims that he was hit on the head with a hammer. He is only complaining of pain around the site of the injury. On examination there is haematoma present, but no laceration. Standard skull views reveal no bony injury. You suspect a depressed skull fracture and wonder whether a tangential radiograph of the site of the injury, or a CT scan would be better able to detect it.

    Three part question

    In [patients presenting with head injury and suspicion of depressed skull fracture] is [tangential radiograph or CT scan better] at [detecting depressed skull fracture].

    Search strategy

    Medline 1966–04/02 using the OVID interface. [exp skull fractures OR exp skull fracture, depressed OR ({skull.mp OR cranium.mp OR calvarium.mp} AND {fracture.mp AND depressed.mp})] AND [exp x-rays OR x-rays.mp OR roentgenogram.mp OR tangential.mp OR oblique.mp] AND [exp tomography, x-ray computed OR ct.mp OR tomography.mp OR ct scan$.mp] LIMIT to human AND English.

    Search outcome

    Altogether 40 papers were found. None of the papers answered the three part question.

    Comment(s)

    Intuitively it would seem that CT scan is the best method available to investigate such injuries. However, there is no evidence to show that it is better than tangential skull views.

    CLINICAL BOTTOM LINE

    Local neurosurgical advice should be followed.

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