X-ray Films of the Skull In Trauma Cases

To the Editor.— The implicit recommendation given to the widespread use of x-ray films of the skull in all cases of head trauma, which was the subject ofLaw and Medicinein the Oct 30,1972, issue ofThe Journal, is contrary to the prudent practice of medicine. In fact, a previousLaw and Medicinearticle (Feb 28,1972) was a good deal more realistic on this same subject. In an article by Bell and Loop entitled "The Utility and Futility of Radiographic Skull Examinations for Trauma," 1 it was determined that if skull examinations for trauma were reserved only for a group of patients demonstrating certain clinical findings and omitted in all other patients with trauma, the yearly saving in health care costs would be $15 million, with no adverse effect on the patient's medical care. In another article on the subject, Roberts and Shopfner 2 point out in the analysis