Introduction Bruising is a common finding among children, arising from both accidental and non-accidental injury (NAI). Paediatricians are often asked for an opinion on causation, or to discern the difference between bruises and innocuous skin lesions. NICE guidance on ‘thresholds’ for suspecting child maltreatment exist, but there is only a limited evidence base for paediatricians to draw on, yet their opinion will have a profound impact on families.

Aim To audit the ability of paediatricians in assessing common skin lesions, and identification of bruising suspicious for NAI.

Methods A slideshow was created of 7 skin lesions of known provenance: two birthmarks (Mongolian spot and café-au-lait spots), two accidental bruises and three abusive bruises (ear bruise in an infant, facial bruise in baby, slap mark on a toddler). We measured participants’ assessments of these lesions by scoring their concern for child maltreatment as the underlying cause, using a scale of one (no risk) to four (high risk), adapted from the NICE safeguarding guideline. Demographic details were collected including: current grade, years of experience in paediatrics, area of work, and level of safeguarding training undertaken. The study was registered with the local Quality Improvement department.

Results Sixty-three physicians participated. 48% worked within general paediatrics, the rest working in specialties/community. 90% had received safeguarding training. Little difference was seen on subgroup anaylsis by years’ experience (51% of group in paediatrics for >5 years) or level of safeguarding training (57% completed RCPCH level three).

Conclusions Correctly identifying NAI is vital for paediatricians. Most high risk cases were identified, but despite high levels of safeguarding training, there was considerable variability of impressions across common clinical scenarios. Were staff ‘worried’ about under-recognising NAI and thus over interpreting some cases? The national need for local audit/evaluation of safeguarding assessors and assessments should be considered.