Radiographers' role and practice in suspected cases of child physical abuse in Malta

While many injuries in infants are accidental, some may indicate physical abuse, necessitating vigilance from healthcare professionals. Radiographers play a critical role in the detection of Suspected Child Physical Abuse (SCPA), facilitating timely interventionand mitigating long-term morbidity and potential mortality. The purpose of this study was to investigate the role of Maltese radiographers and their current clinical practice in the detection of SCPA.

A prospective, cross-sectional study design was implemented, with data collected via a self-designed online questionnaire distributed to 44 radiographers working in the Accident and Emergency (A&E) department of a public general hospital or Primary Health Care (PHC) Centres in Malta.

Thirty-six of 44 invited radiographers completed the questionnaire, yielding a response rate of 81.8%. Most radiographers (66.7%) encountered SCPA in clinical practice, with 47.2% reporting occasional cases. All participants demonstrated an understanding of how to determine SCPA, frequently mentioning physical indicators, behavioural signs in children and accompanying adult(s). Notably, 61.1% recognised the detection and reporting of SCPA as part of their professional responsibilities. However, 83.4% reported limited familiarity with radiological signs of SCPA, reflecting gaps in specialised training. This was further evident in the image-based section of the questionnaire, where discrepancies in image interpretation noted variability in knowledge and diagnostic accuracy.

The study revealed that radiographers employ a variety of evaluative approaches to identify or raise concerns related to SCPA. While most local radiographers recognised their role and demonstrated an understanding of SCPA, this study revealed gaps in knowledge, awareness,and inconsistent radiographic interpretation. Similar to previously published concerns, these inconsistencies may impede timely and effective intervention, indicating the need for enhanced education, training and clearer clinical protocols.

This study highlights the need to improve radiographers' accuracy in detecting SCPA to ensure effective management. Continuous professional development, specialised training, and clear procedural guidelines are imperative to support radiographers' safeguarding responsibilities towards children suspected of experiencing abuse.

Some injuries in infants may be a sign of physical abuse, and healthcare professionals play an important role in recognising these concerns early. This study investigated the safeguarding responsibilities of radiographers practising in Malta in relation to the identification of suspected physical abuse in children. This study found that most radiographers understood their safeguarding role and had encountered possible cases, but many reported limited knowledge of imaging signs and showed differences in image interpretation. This matters because better training and clearer guidance could help radiographers identify concerns more accurately and support timely protection for children.