Identifying paediatric non-accidental injuries: South African diagnostic radiographers' perceptions

Paediatric non-accidental injuries (NAIs) are injuries resulting from physical child abuse. These injuries are frequently not disclosed by caregivers when the paediatric patients present to emergency departments, a challenge exacerbated by the patient's dependence on adults and limited ability to communicate abuse. Consequently, healthcare professionals (HCPs), including diagnostic radiographers, play a critical role in recognising inconsistencies in patient history, clinical presentation and radiological findings that may indicate NAI. However, existing literature highlights knowledge gaps among radiographers and ongoing challenges in identifying paediatric NAI during imaging. Therefore, this study aimed to explore and describe diagnostic radiographers' perceptions of identifying paediatric NAIs in public hospitals in Ekurhuleni, South Africa.

A qualitative, exploratory, and descriptive design was used to investigate diagnostic radiographers' perceptions of identifying paediatric NAIs in public hospitals in Ekurhuleni, South Africa. Semi-structured, face-to-face interviews were conducted, and data were analysed using Braun and Clarke's reflexive thematic analysis (RTA).

Two overarching themes emerged: (1) barriers to effective identification of paediatric NAI and (2) key supports for recognising NAI. Four sub-themes were associated with the barriers theme: conceptual gaps in understanding paediatric NAI, perceptions of limited professional scope, difficulties in recognising NAI, and lack of sufficient clinical information; while three sub-themes described key supports, including comprehensive history-taking, clinical reasoning and behavioural contextualisation, and procedural opportunities to observe physical signs of abuse.

Findings mirror those of international research and the only existing South African study from KwaZulu-Natal (KZN), indicating that radiographers across contexts encounter similar difficulties in identifying NAI. Although several enabling factors were identified, persistent barriers highlight the need for strengthened educational preparation and institutional support to improve compliance with South African child protection legislation and enhance child protection practices within radiology.

Children who experience physical abuse may have injuries that are not immediately recognised when they come to hospital. This study interviewed diagnostic radiographers in public hospitals in South Africa to explore their experiences of identifying injuries that may be linked to child abuse. This study found that radiographers faced challenges such as limited knowledge, uncertainty about their role, and lack of clinical information, while careful history-taking, observation, and clinical reasoning helped support identification. This matters because better education and workplace support may help healthcare professionals recognise concerns earlier and strengthen child protection.