The impact of sedation on the quality of initial skeletal surveys performed for suspected physical abuse in children: a comparative two-centre audit

Abstract

BackgroundThe impact of sedation on the quality of initial skeletal surveys performed for suspected physical abuse in children is not known. ObjectiveTo assess whether sedation influenced the number of, reason for, and effective dose of repeat radiographs obtained as part of initial skeletal surveys, and mean examination times. Materials and methodsOne hundred consecutive antemortem initial skeletal survey examinations performed for suspected physical abuse in children <2 years were retrieved from two tertiary paediatric hospitals: Centre 1, where sedation is not used for initial skeletal survey imaging; and Centre 2, where sedation is used routinely. ResultsIn total, 4,055 radiographic projections were performed, of which 93 (2.3%) were repeats. Comparing centres, there was a significant difference in the total number of repeats (P=0.001) and the number of repeats in children <12 months (P=0.008). Mean examination times were significantly shorter in unsedated children (P=0.005), even after outliers were excluded (P=0.002). There was no significant difference between the number of routine projections (P=0.587), incompletely imaged body parts (P=0.254), rotation/suboptimal positioning (P=0.527), repeats in children >12 months (P=0.089), routine projections in children <12 months (P=0.642) or >12 months (P=0.979) or effective doses of repeats (P=0.286). ConclusionThere were fewer repeat projections in sedated children and those <12 months but examination times were significantly longer. There was no difference in the effective doses of repeats. The routine use of sedation is not supported if the primary considerations are reducing radiation dose and examination time when performing skeletal survey imaging.