Skeletal survey quality in non-accidental injury – A single site evaluation of the effects of imaging checklists

• Skeletal survey examinations for non-accidental practices have been shown to vary in content and in quality.
• Checklists have demonstrated improvements in compliance to guidelines across health disciplines and in various settings.
• Practice was assessed following the introduction of checklists using a modified scoring system against national standards.
• Improvement in the content and quality were observed in all three measures.
• Imaging checklists demonstrated improvements to skeletal survey examination content and quality.

AimsEvidence suggests ongoing practice variability in the quality of skeletal survey examinations for non-accidental injury. The purpose of the study was to investigate the effects on examination quality following the implementation of imaging checklists.MethodA retrospective evaluation of skeletal survey examinations was carried out on studies performed between January 2007 and November 2014 at a large District General Hospital Trust. Longitudinal assessment was undertaken over three periods, before and following the introduction of two versions of imaging checklists, following modifications. Examinations were assessed and scored using three measures for completeness and quality employing a modified established scoring system against a professional body national standards document.ResultsA total of 121 examinations met the inclusion criteria, all quality assessment measures showed improvements between each period. Examination completeness increased from median of 13 projections, to 20 throughout the three periods. Mann Whitney u Tests showed significant differences between each period. The mean combined anatomy score reduced from 3.11 to 1.10 throughout the three periods. Independent t Tests and Mann Whitney u Tests showed a significant decrease throughout the study period. Total percentage examination quality increased from median 44–83% throughout the three periods. Independent t Tests also showed significant differences between each period.ConclusionThe use of imaging checklists to improve quality and to support the optimal acquisition of the non-accidental injury skeletal survey shows encouraging results. However, further work is needed to optimise content and the use of checklists in practice.