Background The type of fracture alone cannot ascertain associated safeguarding/child protection issues, and it is therefore important to carefully assess and document each case. It is expected that all fractures under 18 months are discussed with the paediatric team in view of the raised likelihood of abusive cause in this age group.

Aims To assess whether fractures in children less than 18 months of age presenting to the emergency department (ED)are discussed with a consultant paediatrician; and to review documentation and which team(s) managed fractures in this age group.

Methods Children under 18 months of age having skeletal x-rays between September 2010–11 were identified from the Radiology IT system. For those showing a fracture information was gathered from clinical IT systems, ED notes, and hospital case notes.The type of fracture, mechanism of injury, and time to presentation were reviewed. It was determined whether the patient was discussed with a consultant paediatrician; and whether management involved the paediatric team or was solely by the ED or orthopaedic team.

Results 209 x-ray reports (in 162 children) were reviewed and 55 fractures identified. Three were excluded as ED notes not found. Age range was: 0–6 months 7 fractures; 6–12 months 40 and 12–18 months 8. See table 1 for fracture types. The time interval between injury and presentation was recorded in 27(51%)- (74% <24 hours vs. 26% >24 hours).The mechanism of injury was noted in 36(70%). 21(40%) were discussed with a consultant paediatrician of whom 2 had abusive fractures. 17(33%) were referred to orthopaedics alone; and 14(27%)were managed only by ED.

Conclusions Documentation and discussion with paediatrician was inadequate. Clavicular fracture was most frequent and finger crush fractures quite common. It was not possible to judge accurately which cases were checked for social services involvement by ED. Further awareness-raising with ED staff followed by re-audit is planned.