High-Yield Referral Criteria for Posttraumatic Skull Roentgenography: Response of Physicians and Accuracy of Criteria

Richard O. Cummins, James P. Logerfo, Thomas S. Inui, Noel S. Weiss

Research output: Contribution to journalArticle

23 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)673-676
Number of pages4
JournalJAMA: The Journal of the American Medical Association
Issue number7
StatePublished - Aug 15 1980
Externally publishedYes


ASJC Scopus subject areas

  • Medicine(all)

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