MaltaToday | 18 May 2008 | Report warns against ‘futile’ skull X-rays in hospital

NEWS | Sunday, 18 May 2008

Report warns against ‘futile’ skull X-rays in hospital

James Debono

Far too many futile skull X-rays are being performed in hospital, a study published in last March’s edition of the Malta Medical Journal reveals.
The study authored by three medical dotors namely Mary Rose Cassar, David Ellul, Tatyana Mintoff, Mark Camilleri was conducted between February and March in 2006, and shows that at least 306 patients were exposed to “unnecessary radiation.”
The report states that skull X-rays are a routine procedure for patients with any form of head injury. Although exposure to this kind of radiation is not deemed exceptionally harmful, it is expensive to perform and best avoided.
Only six of those X-rayed had fractures and went on to have full CT scans – the only conclusive study to exclude serious head injury.
In fact, a total of 312 out of 387 patients who presented themselves with a head injury in the emergency department had their skulls X-rayed. The authors of the report contend that if international guidelines were strictly abided to, only two of those patients would have required an X-ray.
Guidelines issued by the National Institute for Clinical Excellence in the UK advocate a strategy based on early computed tomography (CT) scanning for patients deemed clinically to be at high risk, and a major reduction in the use of X-rays.
If international head injury guidelines were applied, there would be a significant decrease in skull X-rays, as only children with suspected non-accidental injury would be X-rayed. “This will therefore lead to significant cuts in costs and unnecessary radiation exposure,” the report claims.
The same report also reveals that there were no standard criteria for the request of CT scans by doctors. Twenty-five CT scans conducted in the same period were not required by international guidelines; on the other hand, 23 patients who would have qualified for a CT scan did not undergo the test.
“These results are of concern and highlight the urgent need for the implementation of standard guidelines,” the report concludes.
“The aim of the study was to compare our practices in the management of head injury to UK, which is the country we usually approach mostly in our medical management,” Dr Mary Rose Muscat told MaltaToday.
“When we compared our practice with these NICE guidelines, we did find out that we take too many skull x-rays and we argued the benefits that would be achieved if we were to adopt these English guidelines. We were hoping to inspire a medical discussion to have this system also in Malta,” Muscat told MaltaToday.
Asked whether new guidlelines will be issued to regulate this sector, Muscat explained that this can only take place after discussion involving the Surgical, A&E and Radiology departments in the hospital.

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