The effect on patients of non-referral for skull radiography following mild head injury

Abstract This paper assesses the attitude of 705 patients who attended the Accident department of a large metropolitan district general hospital, with a mild head injury and who were not referred for skull radiography. A questionnaire was sent to patients 5–7 months after they had attended. Fifty-one per cent had expected an X-ray, and, when this did not occur, the majority of this group (63 per cent) left the Accident department disappointed. Furthermore, the duration of symptoms in this group was prolonged. The introduction of guidelines may reduce clinically unnecessary X-ray examinations, but some of the consequences may not be fully appreciated. In this study, a significant number of patients were dissatisfied with the lack of X-ray referral. The main cause for the associated prolongation of symptoms is not clear, but a contributory factory may be that lack of referral for radiography led to anxiety concerning the thoroughness of their management.