Extradural haematoma in a child after an apparently mild head injury.

About one million head injured patients attend accident and emergency departments each yearroughly 10% of all attenders.' Most are fully alert and orientated on presentation with no abnormal neurological signs and their injuries may therefore be classified as mild.2 However, some patients presenting in this way have sustained a skull fracture a major risk factor for extradural haematoma.3 Guidelines on selecting patients for radiography after head injury produced by The Royal College of Radiologists state the indications as a history of loss of consciousness or amnesia at any time, focal neurological symptoms or signs, cerebrospinal fluid or blood from the nose or ear, suspected penetrating injury, or difficulty in assessing the patient because of additional pathological findings such as stroke, seizure, or mental handicap.4 On these criteria the proportion ofhead injured patients referred for radiography is around 50% in most studies.56