Aims To audit current practice and develop guidelines on the ordering of skeletal surveys in patients <2 yo presenting with fractures to our ED department

Methods We used the guideline published in Paediatrics: “Development of Guidelines for Skeletal Survey in Young Children with Fractures”.¹ Using our online server we reviewed data over two years (2012–2013). Patients <24 months and any patient presenting with a fracture presenting to ED were included. In accordance with the guideline, data audited included age (0–11 ms, 12–23 ms), developmental status (ambulatory v non-ambulatory), time from fracture to presentation, history and mechanism of injury, pertinent features on examination, existent co-morbidities, radiological characteristics and age of fracture, decision to skeletal survey and time from fracture to skeletal survey.

Results 59 patients were identified over the two year period (range 22 days–23 months). 20.3% (n = 12) were between 0–11 ms, 79.7% (n = 47) were between 12–23 ms. 1 patient (1.7%) aged 9 ms had a skeletal survey. If the above guideline had been applied, 40.7% of this patient cohort would have warranted a skeletal survey, and 75% (n = 9) of our 0–11 agegroup and 31.9% (n = 15) of our 12–23 agegroup would have qualified for a skeletal survey.

Conclusion In a busy ED department with short physician-patient interaction a systematic approach to child protection is of paramount importance. This data suggests that our centre is under-utilising skeletal surveys in the management of children under the age of 2 presenting with fractures to our ED department. Significant cultural differences may impact on the relevance of this guideline for our patient population. We are developing a new protocol to help ED doctors decide when a skeletal survey is appropriate in vulnerable children.

Reference

1. Wood JN, Fakeye O, Feudtner C, et al. Development of guidelines for skeletal survey in young children with fractures. Pediatrics. Originally published online June 16 2014, DOI: 10: 10.1542/peds.2013-3242.