Retrospective analysis of 12,072 pediatric head injury cases admitted to hospital revealed 159 patients with intracranial complications: 132 had intracranial hematoma and 27 had diffuse brain swelling. Multivariate analysis revealed two risk factors that could be recognized easily by primary-care physicians. They were found to be significant in predicting the development of intracranial complications. These risk factors were impairment of consciousness at the time of admission and clinical and/or radiological skull fracture. Analysis revealed that the combination of impaired consciousness and skull fracture carried the highest risk of complication (75%); however, the presence of impaired consciousness alone had an intermediate level of risk (19%). The presence of skull fracture alone carried a small overall risk (2%); however, this was highly dependent on age. The absence of all the risk factors considered carried a negligible risk of intracranial complications, provided proper skull X-rays were taken and correctly interpreted.