title: Improving national standards of child protection skeletal surveys: the value of College guidance.
abstract: OBJECTIVE
  To re-assess the content and quality of skeletal surveys performed in the investigation of non-accidental injury following the publication of nationally agreed guidelines produced jointly by the Royal College of Radiologists and the Royal College of Paediatrics and Child Health in 2008.
  
  
  METHODS
  One hundred consecutive skeletal surveys performed in England, which were sent to a tertiary paediatric hospital for a second opinion, were reviewed for their content and quality. The number and type of view was assessed with reference to the 21 recommended views as set out in the College guidance. The quality of each view was assessed and given a score up to a maximum of 10.
  
  
  RESULTS
  A total of 2,294 radiographic views were acquired, with an average of 22.9 per survey (range 12-21). Fifty-one of the surveys contained all 21 recommended views (previously 15%). The average quality score per view was 9.7/10 (97%), previously 9.7/11 (88%). The commonest cause of reduced quality was the presence of an artefact on the image.
  
  
  CONCLUSIONS
  There has been an improvement in the content of skeletal surveys performed in England, which in part may be due to the publication of the national joint Royal College guidance; however, there remain areas for continued development in order to improve practice further.
authors: Birmingahm Children's Hospital, Birmingham, UK. Electronic address: hiten.patel@doctors.org.uk.
authors: H
authors: H
authors: Patel
authors: The Leeds Teaching Hospitals, Leeds, UK.
authors: S
authors: S
authors: Swinson
authors: Birmingahm Children's Hospital, Birmingham, UK.
authors: K
authors: K
authors: Johnson
mesh_terms: D002648:Child; D002649:Child Abuse / Q000145:classification / Q000175:diagnosis* / Q000706:statistics & numerical data; D002675:Child, Preschool; D004282:Documentation / Q000592:standards*; D005260:Female; D050723:Fractures, Bone / Q000145:classification / Q000000981:diagnostic imaging* / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019221:Mandatory Reporting; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000592:standards; D011859:Radiography / Q000592:standards* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D006113:United Kingdom / Q000453:epidemiology