부산대학교 도서관

AimTo audit compliance with local policy and RCPCH/RCR recommendation that all children under the age of two year who have a skeletal survey as part of a child protection investigation have follow up radiological imaging (either a full skeletal survey or chest x-ray with oblique view of ribs) two weeks after initial imaging. In addition we aimed to assess the value of the skeletal survey in terms of identifying new injuries in children in our busy paediatric hospital.MethodsA five year (2012–2016 inclusive) retrospective analysis of radiology records and electronically archived in-patient notes was performed for all children under the age of two who underwent skeletal surveys as part of a child protection investigation. Reports of all skeletal surveys were analysed and cases where new injuries were identified were recorded. The standard was that all children had repeat imaging at 14 days and electronic records were checked to see if this imaging took place.Results246 children had a skeletal survey as part of a child protection investigation in our hospital. 41 of these were excluded as they were referred from another health board to tertiary services in the hospital and follow up notes could not be accessed. Of the remaining 205 children 170 (83%) received either a follow up skeletal survey or chest X-ray at 14 days. A new injury was identified in 28 (13.7%) of children who underwent recommended imaging as part of a child protection investigation. The initial skeletal survey identified a new injury in 23 (11.3%) children, a further 5 (2.4%) children had injury demonstrated on secondary imaging with negative first skeletal survey. Of the 170 children that underwent follow up imaging a new fracture was found in a total of 11 (6.5%) cases (5 where original skeletal survey was negative; 6 where original skeletal survey was positive).ConclusionAdherence to local and national standards could be improved, with 35/205 (17%) of children not having had follow up radiological imaging. The positive results from skeletal survey (13.7%) and follow-up imaging (6.5%) suggests that these investigations have an important role in the assessment and identification of potential abuse.