Skeletal surveys for suspected physical abuse [QSI Ref: XR-505, XR-512]

Compliance with the latest RCR guidance regarding the investigation of suspected physical abuse in children under the age of two.

The first radiological investigation of suspected physical abuse in children is often the skeletal survey. The purpose of a skeletal survey is to provide a standard series of radiographic images that will visualise the entire skeleton.  Not only can skeletal surveys characterise the nature of a fracture they can assist in dating an injury and identify further occult fractures. The results of medical imaging may have significant social and medico-legal implications. Consequently it is imperative that radiological assessment is timely and accurate.  The Royal College of Radiologists and the Society and College of Radiographers (SCoR) have updated pre-existing guidance in a document endorsed by the Royal College of Paediatrics and Child Health entitled The radiological investigation of suspected physical abuse in children.1 

The standard: 

The following standards are taken from this document:

• The skeletal survey should be acquired and reported within 24 hours and certainly no later than 72 hours from the request being made

• A skeletal survey should include a standard set of views outlined within the appendix

• Follow-up imaging should be performed in all children within 11 to 14 days and no later than 28 days after the initial skeletal survey

• Follow up imaging should include views outlined within the appendix

Target: 

100%

Indicators: 

Percentage of examinations which adhere to the standards outlined in the latest RCR guidance

Data items to be collected: 

• Assess retrospectively a sample of recent investigations

• Record the time interval between the skeletal survey being reported and the request being made

• Identify radiographic views missing or incomplete on the initial skeletal survey

• Record the time interval between the initial skeletal survey and follow-up imaging

• Identify radiographic views missing or incomplete on follow-up imaging

Suggested number: 

25 consecutive patients

• Present the results of the audit to the radiographers and radiologists and potentially to paediatric colleagues

• Discuss the causes of failure to meet the standard and identify staff members responsible for taking action to improve adherence

• Keep the protocol readily available in the department

• Review and re-audit within 6-12 months, depending on patient frequency

1. Society and College of Radiographers and The Royal College of Radiologists. The radiological investigation of suspected physical abuse in children, revised first edition. November 2018 https://www.rcr.ac.uk/publication/radiological-investigation-suspected-physical-abuse-children

2. Royal College of Radiologists. Standards for Radiological Investigations of Suspected Non-accidental Injury. Joint document produced in collaboration with the Royal College of Paediatrics and Child Health. London: RCR, 2008. BFCR(08)1

Dr Owen Arthurs and Dr Sue Barter, updated by R Spencer