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Quality improvement
Improving rates of appropriate skeletal survey use in a district general paediatric emergency department
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  • Published on: 17 September 2021
    Skeletal Surveys in a District General Hospital - coming from the opposite direction.
    • anthony cohn, Consultant Paediatrician Watford General Hospital
    • Other Contributors:
      • Anand Parmar, F2 Doctor

    We read this paper with great interest. We have been investigating the use of skeletal surveys in our hospital and have come to an entirely different conclusion due to very different results. We have collected data over 13 years during which time 117 skeletal surveys were undertaken as part of the investigation into possible non accidental injury (NAI). We only detected additional fractures in 4 cases each of which presented with significant risk factors -E.g. multiple injuries, very young age, rib fractures. We have been concerned that the number of SS undertaken with a negative result suggests that we have been overusing this investigation.

    Our results reflect a fairly liberal interpretation of the RCPCH guidance that 'when physical abuse is suspected, thorough investigation to exclude occult injury is required' 1. In practice most children under 2 presenting with any unexplained injury will have a skeletal survey.

    As with every investigation we need to decide what levels of sensitivity and specificity are realistically obtainable, if every skeletal survey that we do shows additional fractures we are clearly not doing enough, but if they are only detected occasionally we are probably doing too many.

    It is likely that the use of SS is variable across the country, and perhaps a national review of practice and outcomes would allow us to to produce more clear instructions - as highlighted in this paper to determine which children need a s...

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    Conflict of Interest:
    None declared.