945 Usefulness of Skull X-Ray in diagnosis and management of craniosynostosis and suspected NAI in children less than 4 years, results of three years retrospective observational study

Published Date: 17th August 2022

Publication Authors: Ahmad A, Hamed Z, Vataha K, Abdelaziz M

Aims
Evidence for the indications of skull X rays (SXR) in children is limited. There is substantial evidence to suggest that children are more susceptible to the effects of ionizing radiation than adult. The risks from exposure to ionizing radiation are dependent on the age at which exposure occurs, and that exposure during childhood results in a likely two- to three-fold increase in lifetime risk for certain detrimental effects (including solid cancers) compared with that in an adult.

The aim of this audit was to evaluate the indications of skull X-rays in children below the age of 4 years, to assess the use of skull X-ray as initial investigation for suspected non-accidental injury (NAI) and to assess the impact of skull X-ray on the diagnosis and management of Craniosynostosis.

Methods
A retrospective review of the health records of children under 4 years old, who had a skull x-ray in UK based hospital was conducted over a 3 year period from January 2017 to December 2019. All patient aged four and under who underwent skull X-ray were identified using records from radiology department and midwifes registry. The data were collected by the clinicians involved in the study and further analysed by the statistical team from QI-CA department.

Results
We identified 109 patients underwent skull X-rays and 112 X-rays performed in total. Three patients had two scans during the period of the study. Nearly 80% of all requested skull x-ray in studied population were normal. The indications for skull x-ray were mostly for abnormal head shape and possibility of craniosynostosis or as part of NAI investigations. The two major indications for skull X-ray were to exclude craniosynostosis/plagiocephaly or as a part of investigation for suspected NAI.

53 skull X-rays were done for craniosynostosis/plagiocephaly, 7 of them were abnormal (13%). All cases with abnormal results were referred for further follow-up apart from one case who had further normal CT locally and discharged.

27 patients had skull x-rays for suspected NAI, 8 were abnormal (30%).

Conclusion
No clear guidelines or evidence for the indications of SXR in children is available neither locally nor nationally. furthermore, Skull x-ray on it is own cannot rule out craniosynostosis when high clinical suspicion is present. A clear local and national guideline needs to be established to outline the indications for the skull X-ray in young children. In order to facilitate this, further research is required. The data in our study can be the base for future studies.

 

Ahmad, A; Hamed, Z; Vataha, K; Abdelaziz, M. (2022). 945 Usefulness of Skull X-Ray in diagnosis and management of craniosynostosis and suspected NAI in children less than 4 years, results of three years retrospective observational study. Archives of Disease in Childhood. 107(Suppl 2), pp.A465-A466. [Online]. Available at: https://adc.bmj.com/content/107/Suppl_2/A465 [Accessed 22 December 2022]

« Back