Universität zu Köln

Dargel, Susanne, Stenzel, Martin, Stoever, Brigitte, Schleussner, Ekkehard, Wittschieber, Daniel, Banaschak, Sibylle and Mentzel, Hans-Joachim (2021). Guideline adherence and quality assurance in radiological diagnostics in cases of suspected child abuse in Germany. Radiologe, 61 (10). S. 947 - 955. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1432-2102

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Abstract

Background Diagnostic imaging plays a key role in the evaluation of non-accidental consequences of injuries in childhood. Fractures are the second most common consequence of child abuse, after skin lesions such as abrasions or bleeding. With the evidence of radiological criteria, non-accidental fractures can be differentiated from accidental fractures. Special types of fractures such as the classic metaphyseal lesion can only be differentiated if the image quality is high. Aim The goal of this prospective study was to assess adherence to guidelines and quality assurance of radiological diagnostics in the event of suspected abuse in Germany. For this purpose, the quantity and diagnostic quality in university and non-university hospitals as well as the existence of a pediatric radiology department were analyzed. Materials and methods In all, 958 X-ray examinations of 114 suspected abuse cases (46 girls, 68 boys) were evaluated; 42 cases from university, 42 from maximum care and 30 from regular care clinics with a median age of 6 months (3 weeks-3 years of age) were assessed as DICOM data by 3 pediatric radiologists in a consensus procedure with regard to adherence to guidelines and various quality parameters. An accompanying questionnaire was used to compare the theoretical knowledge with the respective practical implementation. Results A mean of 8.4 X-rays (range 1-22) were made per case. In 12 of 114 assessed cases (10%) there was a complete skeletal status according to the S1 guideline. A babygram was performed in 13 cases (10.5%). Departments with focus on pediatric radiology produced significantly more X-rays per skeletal status than facilities without this specialization (p < 0.04). Significantly higher qualitative implementation was recorded in university hospitals (p < 0.001). Regardless of the type of institution, there was only marginal agreement between the questionnaire response and the available image material. Conclusion In Germany, a guideline-compliant procedure in the event of suspected child abuse is largely lacking. It remains to be seen whether this will change in the future with the broader implementation of child protection groups and the S3+ child protection guideline adopted in 2019 (AWMF register 027-069). The establishment of reference centers for a second diagnosis and recommendations for imaging technology can also improve the quality of care over the long term.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Dargel, Susanne UNSPECIFIED UNSPECIFIED UNSPECIFIED Stenzel, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Stoever, Brigitte UNSPECIFIED UNSPECIFIED UNSPECIFIED Schleussner, Ekkehard UNSPECIFIED UNSPECIFIED UNSPECIFIED Wittschieber, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Banaschak, Sibylle UNSPECIFIED UNSPECIFIED UNSPECIFIED Mentzel, Hans-Joachim UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-588214
DOI:	10.1007/s00117-021-00872-w
Journal or Publication Title:	Radiologe
Volume:	61
Number:	10
Page Range:	S. 947 - 955
Date:	2021
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1432-2102
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language SKELETAL SURVEYS; FRACTURES Multiple languages Radiology, Nuclear Medicine & Medical Imaging Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/58821