LAUSR

Background In 2017, the Royal College of Radiologists (RCR) published updated guidance on the radiological investigation of suspected physical abuse in children. New recommendations include CT head in all children under one year and that siblings or household contacts under two should also undergo radiological investigation. The latest guidance also recommends that all skeletal surveys are reported by two independent paediatric radiologists. Aims To audit current practice and assess the impact of introducing the RCR (2017) guidance in terms additional imaging needing to be performed. To assess the impact on workload of introducing double reporting for skeletal surveys. Methods Children under two who had suspected physical abuse were identified from the child protection team’s referral log. A retrospective analysis was performed of skeletal surveys from December 2014 to December 2016 using an audit proforma devised from the RCR guidelines (2017). IT systems were used to check for siblings aged ≤2 years. PACS was used to assess views obtained, time of final report and if surveys were double reported. Results 18 skeletal surveys were performed in the study period, all of which were deemed necessary. Results showed that compliance with the RCR guidance (2008) needed improvement: two skeletal surveys had missing views, only 20% of children who had an abnormal CT head had a follow-up MRI, 72% of skeletal surveys were reported within 72 hours and just 17% of children had follow-up imaging. If the RCR 2017 guidance were to be introduced, an additional three CT head scans would be required per year and two skeletal surveys would be required for siblings or household contacts. Double reporting would be required for 9 skeletal surveys per year. Conclusion New recommendations have implications for radiation dose but from the results, it would not increase the workload to an unmanageable degree. Based on results, we have chosen to introduce the latest RCR guidelines with the use of a proforma to improve compliance with standards.