Childhood head injuries and the skull roentgenogram

The skull roentgenogram has become a routine screen in cases of head injury. The medicolegal aspects of head injury are the major stumbling block to the widespread application of criteria mentioned in this article. Most physicians can work within the framework suggested by these criteria, but it is when one feels that even though clinical examination suggests that skull roentgenograms are not required, the threat of medicolegal complications is so great that one should obtain these studies as a screen or cover. The current problems of rising malpractice insurance costs, the fear of the overzealous attorney, and the fear of having one's practice and life irreparably damaged by a large lawsuit play a big part in one's adoption of such an attitude. Clearly, this is not a laudable situation, but at the moment it is not so much one of choice as one of necessity. In many ways it is reminiscent of the problem experienced in previous years with the diagnosis and reporting of suspected battered children. The answer to that problem, because of the legal ramifications, was in the passage of appropriate legislation. It may be that this is where the solution lies with head injury and the skull roentgenogram. Otherwise, one should expect a continued less than sensible use of the skull roentgenogram in cases of childhood head injury.