G159(P) Using skeletal surveys to investigate suspected physical abuse – are we over-investigating?. (12th March 2018) - Beatty, C
Abstract : Aims: My audit aimed to establish if our department was upholding national guidelines on the use of skeletal surveys in child protection (CP) medicals. Specifically: performing skeletal surveys in suspected physical abuse under 2 years; documenting reasons not to if investigation not done; and performing investigations within 72 hours for inpatients. I also used the data to assess rates of identifying undiagnosed fractures. Methods: I retrospectively reviewed case notes and radiology requests to establish how many children underwent skeletal surveys in the audit period, their ages, reason for and timeliness of investigation, and whether a fracture was identified. This was cross-referenced with a database of all CP medicals done in children under 2 years. In those who did not have a skeletal survey done, I assessed if there was documentation why not. Results: I identified 37 children under 2 years who had a CP medical done and three children over the age of 2 who had a skeletal survey performed. 21/37 under 2 years had skeletal surveys performed. In 20/21 (95.2%) cases the skeletal survey was performed because of suspicion of physical abuse. Of the 16 patients under 2 years who did not have skeletal surveys done, 13/16 (81.3%) had a clearly documented reason for not undertaking the investigation. 20/24 (83.3%) of skeletal surveys were done within 72 hours of request. Of the 24 skeletal surveys done, no fractures were found in 17/24 (70.8%), identified fractures were shown in 5/24 (20.8%), and 2/24 (8.3%) showed previously unidentified fractures. Both of the previously unidentified fractures were in patients under 1 year. Conclusion: My audit showed that our trust is upholding the RCPCH guidance by undertaking skeletal surveys in children under 2 with suspected physical abuse and documenting reasons not to investigate in most cases where we do not perform skeletal survey. However, these investigations are giving a low yield of undiagnosed fractures, which perhaps suggests we are subjecting more patients to radiation than is necessary. Is there scope for modifying the RCPCH advice on who should undergo skeletal surveys?