G227(P) Audit of RCR 2008 Standards For Radiological Investigations of Suspected Non Accidental Injury

Abstract

Aim Review compliance with above guidelines and compare with performance from a previous year. Background RCR and RCPCH consider imaging the injured child critical to the process of child protection. The RCR guideline published in March 2008 seeks to provide an evidence based framework which supports the radiologist in contributing to child protection. It encourages best practise and communication between different agencies working together to safeguard children in the investigation of suspected physical abuse. This follows recommendations from the Climbie enquiry and ensuing legislation. Methodology We compared the performance before (2007-08) and after (2009-10) RCR guidelines were published. Notes were requested from both sites in the trust. The standards to compare were identified and information collected in a proforma. This information was later summarised using Excel spreadsheet. Results 31 case-notes where skeletal survey (SS) was performed over these two periods were reviewed, of these 17 cases were suspected physical abuse, 12 were for unexpected child death/SUDI and 2 were for genetic reasons. •• 17/31 skeletal surveys studied were for presumed NAI, -4/17 before (2007-08); and 13/17 (2009-10) after 2008 guidelines - 2/14 for genetic conditions, 12/14 for child death or SUDI •• Of 17/31 with presumed NAI, presentation included - Bruises 10/17 - Fracture 3/17 - Scalp swelling 4/17 (1 had bruising and scalp swelling) - Occult - suspected shaken baby syndrome •• Communication between paediatrician and carers poorly documented - Concerns 1/3rd (pre) and 2/3rd cases (post) - Explanation of imaging 0/3 (pre) and 1-3/12 (post) - Consent for imaging 0 (pre) and 0 (post) •• Communication between Paediatricians and Radiologists poorly documented, only 2-3/17 cases •• Good performance with respect to - Timing (< 1 day), 3/4 (pre) and 8/13 (post) - Completeness of Skeletal Survey 4/4 (pre) and 12/13 (post) - Verbal report (< 1 day) 4/4 (pre) and 12/13 (post) - Final report (<1 day) 2/4 (pre) and 11/13 (post) •• Report, scope for improvement in -Age of injury 2/2 (pre) and 1/3 (post) - Bone density 3/4 pre) and 2/13 (post) - Differential diagnosis 1/2 (pre) and 4/7 (post) •• Additional information from skeletal survey 2/17, (∼ 12%) Summary The study revealed good performance in completing and reporting skeletal survey but documentation of concerns, explaining pathway, sharing concerns with radiologist and some aspects of reporting were not consistent.