title: An electronic tool for systematic reporting of fractures on skeletal surveys in suspected child abuse: prototype development and physician feedback.
abstract: OBJECTIVE
  To describe a skeletal survey data entry and compilation tool and assess physician attitudes toward this reporting approach.
  
  
  BACKGROUND
  Narrative skeletal survey reports are highly variable and prone to inconsistencies with potential adverse impact on patients.
  
  
  METHODS
  The prototype skeletal survey data entry and compilation tool was developed and introduced into clinical practice at a large urban children's hospital. Pediatric radiologists and child protection team (CPT) pediatricians completed a survey of reporting preferences. Skeletal survey reports between March 1, 2013, and March 1, 2014, were reviewed to assess use of the tool.
  
  
  RESULTS
  The survey response rate was 70% (14/20) for radiologists and 100% (4/4) for CPT pediatricians. Among responding radiologists, 54.5% (6/11) indicated that a skeletal survey data entry and compilation tool was helpful for skeletal surveys with >3 fractures; 80% (8/10) of responding radiologists indicated that tabulated data from prior skeletal survey was helpful when interpreting a follow-up skeletal survey with >3 fractures; 90.9% (10/11) of radiologists thought the tool improved report organization; 72.7% (8/11) thought it improved accuracy. Most radiologists (11/12, 91.7%) and 100% (4/4) of CPT clinicians preferred reports with both free text and a tabulated fracture list for testifying in court when >3 fractures were present. The tool was used in the reporting of 14/23 (61%) skeletal surveys with >3 fractures during a 1-year period. A case example using the application is presented.
  
  
  CONCLUSIONS
  Most radiologists and CPT physicians at our center prefer skeletal survey reports with tabulated data and narrative description; 91.7% (11/12) of radiologists and all CPT clinicians prefer this approach for testifying in court when >3 fractures are present.
authors.affiliation: Pediatric Radiology, Hospital Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Barber
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Bixby
authors.forename: Nicole B
authors.initials: NB
authors.lastname: Morris
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Kleinman
authors.forename: Jeannette M
authors.initials: JM
authors.lastname: Perez-Rossello
authors.forename: Patricia T
authors.initials: PT
authors.lastname: Chang
authors.forename: Paul K
authors.initials: PK
authors.lastname: Kleinman
mesh_terms: D001291:Attitude of Health Personnel; D001842:Bone and Bones / Q000000981:diagnostic imaging; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D003937:Diagnosis, Differential; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D019221:Mandatory Reporting; D010372:Pediatrics / Q000379:methods / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011859:Radiography; D011871:Radiology / Q000379:methods / Q000706:statistics & numerical data; D011873:Radiology Information Systems / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*