The impact of a quality assurance programme on skeletal survey imaging for suspected non-accidental injury

South Africa has one of the highest rates of child abuse. The skeletal survey (SS) is the radiological investigation for suspected paediatric non-accidental injury (NAI). Institutional policy is to perform the SS in accordance with The Royal College of Radiologists (RCR) 2017 guidelines. However, the SS is technically challenging, requiring several views with meticulous attention to radiographic detail. The optimal study is thus not always achieved, resulting in decreased diagnostic accuracy.

To assess pre-intervention Tygerberg Hospital (TBH) compliance with RCR 2017 SS guidelines for suspected NAI and to assess post-intervention TBH compliance with RCR 2017 SS guidelines for suspected NAI.

A retrospective assessment of institutional percentage compliance with RCR 2017 SS guidelines for suspected paediatric NAI was followed by a 12-month educational intervention. Pre- and post-intervention compliance was compared utilizing the chi-square test.

The percentage compliance with standard RCR 2017 SS views in the post-intervention period (mean 21.6/25, 86%) was significantly (P < .01) higher than the pre-intervention period (mean 9/25, 36%). The most significant improvements were in the coned lateral joint and oblique chest views.

The implementation of a simple institutional quality assurance programme has the potential to improve imaging for NAI victims. The programme described is broadly applicable to any healthcare or institutional setting.

This study, based on the RCR 2017 guidelines, forms part of a very small body of work on non-accidental injury quality assurance and is the only such analysis from the African continent.