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August 15, 1980

High-Yield Referral Criteria for Posttraumatic Skull RoentgenographyResponse of Physicians and Accuracy of Criteria

Author Affiliations

From the Robert Wood Johnson Clinical Scholars Program (Dr Cummins), the Departments of Medicine and Health Services (Drs LoGerfo and Inui), and the Department of Epidemiology (Dr Weiss), University of Washington, Seattle. Dr Cummins is temporarily at the London School of Hygiene and Tropical Medicine.

JAMA. 1980;244(7):673-676. doi:10.1001/jama.1980.03310070023021

We evaluated a list of high-yield criteria (HYL) as a means of reducing posttraumatic skull roentgenograms and as a diagnostic test for skull fractures. Physicians requested roentgenograms for 76.9% of head trauma patients in a four-month control period, but for only 46.1% during a four-month experimental period, a relative decrease of 40%. When the experiment ended, roentgenogram use increased to 72% of head trauma patients. The HYL accurately classified 92.5% of the patients with and 84.5% of the patients without pathological conditions. The HYL displayed substantial differences in sensitivity and specificity from HYLs used previously. Clinicians disliked the HYL, believing it was inaccurate and a monitoring device. We conclude that criteria lists can effectively decrease requests for roentgenograms and should be carefully evaluated as diagnostic tests for accuracy and adverse outcomes.

(JAMA 244:673-676, 1980)