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To the Editor.—
In MEDICAL NEWS (214:247,1970), Doctors Fred Roberts and Charles Shopfner say that the only clear indication for x-ray films of the skull after head injury is "detection of a foreign body or depression of the skull."Additional reasons are as follows: (1) the possible presence of a fracture extending into the anterior fossa near the midline, possibly requiring additional films with special projections and close clinical observation for cerebrospinal rhinorrhea; (2) a fracture crossing the groove of the middle meningeal artery (and vein), pointing to the possibility of epidural hematoma; and (3) a fracture line crossing the groove of the superior sagittal or a lateral venous sinus. This would require the maintenance of the head of the patient in an elevated position (New York J Med, 46:1120-1121, 1946).
Ecker A. Indications for X-ray Films of Skull in Children. JAMA. 1971;215(2):297. doi:10.1001/jama.1971.03180150079027