Compliance with skeletal surveys for child abuse in general hospitals: A statewide quality improvement process

Matthew Wanner, Megan B. Marine, Roberta A. Hibbard, Fangqian Ouyang, S. Gregory Jennings, Lindsey Shea, Boaz Karmazyn

Research output: Contribution to journalArticle


OBJECTIVE. The purpose of this study is to perform a statewide quality improvement process to improve compliance with the American College of Radiology (ACR) guidelines in performing skeletal surveys for suspected child abuse. SUBJECTS AND METHODS. We prospectively identified all outside hospital skeletal surveys for suspected child abuse in children younger than 3 years referred to our tertiary children’s hospital in 2016–2017. We included a 3-month baseline and 21-month intervention period. The quality improvement process was based on sending educational material to all ACR member radiologists in the state and making telephone calls to radiology technologist team leaders whenever the surveys were not compliant, followed by e-mails with guidance on performing skeletal surveys. We documented the views obtained and compared them with the ACR guidelines. The percentage of compliance with each individual view was assessed with the chi-square test. The total number of compliant views per survey was evaluated with ANOVA. RESULTS. Two hundred twenty-seven patients (105 female) with a mean age of 0.8 year (SD, 0.67 year; range, 0.01–3 years) were evaluated. These 227 surveys (baseline, n = 27; postintervention, n = 200) were performed at 69 different outside hospitals. Compliance significantly (p = 0.006) improved from 25.9% (7/27) during baseline to 54.0% (108/200) after intervention. There was a nonsignificant trend of improved compliance between the first (51.9%; 41/79) and last 7-month (62.3%; 33/53) periods of intervention. Among individual views, only rib oblique views showed significantly (p = 0.02) improved compliance after the intervention, from 51.9% (14/27) to 73.5% (147/200). CONCLUSION. The compliance rate with ACR guidelines for skeletal surveys in suspected child abuse at outside general hospitals significantly increased after implementation of a quality improvement process.

Original languageEnglish (US)
Pages (from-to)976-981
Number of pages6
JournalAmerican Journal of Roentgenology
Issue number5
StatePublished - May 1 2019


  • American College of Radiology guidelines
  • Child abuse
  • Nonaccidental trauma
  • Outside hospitals
  • Skeletal survey

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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