Criteria for performing a skull radiograph

In 2007 NICE guidance states (1) ".. primary investigation of choice for the detection of acute clinically important brain injuries is CT imaging of the head......Plain X-rays of the skull should not be used to diagnose significant brain injury without prior discussion with a neuroscience unit. However, they are useful as part of the skeletal survey in children presenting with suspected non-accidental injury.."

In 2023 NICE guidance states (2)

• Do not use plain X-rays of the skull to diagnose important traumatic brain injury before a discussion with a neuroscience unit. However, people under 16 presenting with suspected non-accidental injury may need a skeletal survey

Reference:

1. NICE (September 2007). Triage, assessment, investigation and early management of head injury in infants, children and adults
2. NICE (May 2023). Head injury: assessment and early management