Investigating the ability of radiographers to recognise typical non accidental injury fractures in children

Introduction: Child abuse is often underreported by the general population and healthcare professionals for a variety of reasons and, therefore, all avenues to improve the discovery and prevention of child abuse should be explored.  Radiographers are well positioned to identify child abuse and in particular Non Accidental Injuries (N.A.I.); having a wealth of experience in image acquisition and visualisation.  In the Republic of Ireland Health Care professionals are legally required to report suspicious cases as Designated Officers.  Aim: Our aim was to measure radiographers' ability to recognise non-accidental injury fractures in children comparing radiographers from two different European Countries. Method: 22 radiographers working in hospitals in the Republic of Ireland and Slovenia viewed 26 plain radiographic images (13 NAI fractures/13 accidental fractures) and rated their confidence on a scale from 1 to 6 that a fracture was either accidental (1-3) or non-accidental (4-6).  The images were viewed using ViewDex software on a laptop calibrated to DICOM greyscale standard display function.  Viewing conditions were standardised and optimised.  An ROC curve was plotted and sensitivity, specificity and area under the curve (AUC) were calculated for each radiographer. Results: The results demonstrated a difference in values which AUC was statistically significant (P=0.0111)Conclusion:  Further research would be beneficial with more images, full skeletal surveys, and paediatric radiologist(s) as a gold standard for comparison.