Objective Evaluate the quality of the medical opinion and risk analysis in reports of child protection medicals undertaken by paediatricians.

Methods All child protection medical reports for examinations undertaken (Acute admissions and NAI Clinic), between 1^st Jan and 31^st Mar 2015, were reviewed (n=86) and assessed against the following quality criterion:

• Does the report conclude whether it is thought that the injury is accidental or non-accidental?

• Is there a clear conclusion with a clear statement of the level of concern regarding the risk to the child/young person?

• Are the presence/absence of additional concerns documented clearly?

• Was the report subject to peer review?

Methods

Outcomes 11% of the initial proformas did not make a judgment as to whether the injury was felt to be accidental, non-accidental or unclear. A further 29% were recorded as unclear. In the final written reports, 8% did not give a clear conclusion and 10% did not document clearly the presence/absence of additional concerns. 21% of reports were subject to peer review within 2 weeks and 33% within 3 weeks.

Conclusion This quality improvement audit shows that in more than a third of cases the initial conclusion of a child protection medical report is unclear or not documented. There was great clarity in the final written reports however standards regarding peer review and documentation of additional concerns were not met. It is important when writing child protection medical reports that they give a clear conclusion as to whether on balance of probability, the injury is more likely to be accidental or non accidental. Additional concerns should be documented and a risk analysis formulated. Subsequently, a new guideline has been developed on best practice for child protection medical reports, with specific guidance on terminology, impact statements and formulating a risk analysis.