The impact of sedation on the quality of initial skeletal surveys performed for suspected physical abuse in children: A comparative two-centre audit
Publication Details
Paddock, M.
(2024).
The impact of sedation on the quality of initial skeletal surveys performed for suspected physical abuse in children: A comparative two-centre audit.
Clinical Radiology, Early View (Online First).
Abstract
BACKGROUND: The impact of sedation on the quality of initial skeletal surveys performed for suspected physical abuse in children is not known. OBJECTIVE: To assess whether sedation influenced the number of, reason for and effective dose of repeat radiographs obtained as part of initial skeletal surveys, and their mean examination times.
MATERIALS AND METHODS: One 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.
RESULTS: In total, 4055 radiographic projections were performed, of which 93 (2.3%) were repeats. Comparing centres, there was a significant difference in the total number of repeats (P¼0.001) and the number of repeats in children aged <12 months (P¼0.008). Mean examination times were significantly shorter in unsedated children (P¼0.005), even after outliers were excluded (P¼0.002). There was no significant difference between the number of routine projections (P¼0.587), incompletely imaged body parts (P¼0.254), rotation/suboptimal positioning (P¼0.527), repeats in children aged >12 months (P¼0.089), routine projections in children aged <12 months (P¼0.642) or >12 months (P¼0.979) or the effective doses of repeats (P¼0.286).
CONCLUSION: There were fewer repeat projections in sedated children and those aged <12 months but examination times were significantly longer. There was no difference in the effective doses of repeated projections. The routine use of sedation is not supported when
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