Giora & all,
Enjoyed the thread and kudos to you for being the test minimizer! I particularly appreciate the prompt feedback you have given us.
I thought Rob's suggestion from down under, was very reasonable.."no shock or horror!" Since the pre-CT probability of a
clinically significant ICH was small in this playful cherube, a screening radiograph may be a cost effective approach? In fact, one can fail to detect a skull fx. on CT particularly if the slices are in the plane of the fracture.
Rob you said, ".....presence of a fracture in this setting gives a 40 fold increase in need
for n-surgical intervention....if negative then it comes down to
demographic factors [admission versus discharge with sensible
parents/not late at night/no NAI flags/live nearby/doesn't live in the
medico-legally charged US ;-) etc] - interested in opinions"
Could you cite a reference for this 40 fold increase you mention? My readings were that the relative risk of ICH increases 4 fold in an infant with a skull fx.
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