Introduction: Child protection is everyone’s responsibility, including both paediatricians and radiologists. The skeletal survey (SS) is a key imaging tool used in child protection for investigating suspected physical abuse or Non-Accidental Injury (NAI). The SS involves a systematically performed series of radiographic images, including the entire skeleton or specific anatomic regions as appropriate.The SS images include: anterior-posterior (AP) & lateral skull, lateral cervical & lumbar spine, AP & lateral & both obliques of thorax, AP pelvis, AP humeri, AP forearms, posterior-anterior (PA) hands, AP femurs, AP lower legs, AP feet with additional views based on clinical and imaging findings. The SS helps identify acute or healing fractures, metabolic bone disease, skeletal dysplasia, or bony metastases, and distinguish these from normal developmental changes and other anatomic variants.In the United Kingdom (UK), standards for SS in suspected NAI are set by the Royal College of Radiologists (RCR) in The Radiological Investigation of Suspected Physical Abuse in Children (2018). This document aims to help the clinician to address the question: “which children should be imaged when physical abuse is suspected” and advises the use of the RCPCH Child Protection Companion for decision-making in suspected cases of physical abuse.This study aimed to evaluate the use of SS on our paediatric A&E department to determine whether our practice aligns with RCR and RCPCH guidance, and to describe the characteristics of children with suspected NAI investigated with SS.Method: We conducted a retrospective descriptive study of children who underwent SS for suspected NAI between January 2021 and December 2022. Patients included those presenting directly to our A&E and referrals from community paediatric services including Mary Sheridan, Sunshine House, and General Practices.The indication for SS was determined by A&E professionals and images were reported by a paediatric radiologist within 24-72 hours, as recommended by RCR.Data was obtained via Symphony® electronic notes at Guy’s and St Thomas’ NHS Foundation Trust. Data was analysed using Microsoft Excel describing a) demographics, b) indications for SS, c) characteristics of the injuries, and d) if the SS was positive and how this was associated with NAI diagnosis and initiation of child protection procedures.Results: We reviewed 32 cases in total. Overall, 25% of SS had a positive result, spanning all age groups. Most positive cases (62%) were in infants under 1 year of age. Among positive results, 89% occurred in this age group. Of those identified to have a positive SS 67% had multiple fractures, while abnormal CT findings were present in 22% of positive SS cases. (table 1)Conclusion: This is one of the few studies providing descriptive analysis of SS use in suspected NAI within a UK paediatric A&E setting. Positive SS findings strongly influenced the decision to diagnose NAI and initiate safeguarding or child protection procedures, particularly in children under 1 year of age.
