In pediatric head injury evaluation, skull radiographs have a limited role due to high false positives rates and low prevalence. Which statement best describes this limitation?

• A. Are costly and time-consuming
• B. Often miss intracranial injuries despite fracture
• C. Have a high rate of false positives for fracture without intracranial injury
• D. Are the most sensitive test for intracranial hemorrhage

Answer: (C)

The key idea is that skull radiographs in kids with head injury are not reliable for identifying brain injury because they frequently indicate a fracture when there isn’t an intracranial injury. In this setting, the incidence of true intracranial injury is low, so positive findings on X-ray (fractures) do not meaningfully guide management and can lead to unnecessary further testing or concern. This mismatch—radiographic fracture often not pairing with intracranial injury—captures the main limitation.

Radiographs are quick and inexpensive, but they’re not sensitive or specific for intracranial injuries, and many intracranial injuries may occur without a skull fracture. CT remains the preferred imaging when brain injury is suspected. The other statements don’t fit this limitation: skull X-rays aren’t primarily limited by cost or time, they don’t reliably miss intracranial injuries despite a fracture being present, and they are not the most sensitive test for intracranial hemorrhage.