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G333 Raise study; a multicentred study of infants presenting to uk emergency departments that are investigated for skulls fractures

Background Head injury in a young child is a common presentation to emergency departments. Skull fractures in young children often generate concern regarding possible non-accidental injury (NAI). Guidelines produced by the Royal College of Radiology recommend a skeletal survey and CT head in children under 2 years of age, if abusive head injury is suspected. We hypothesise that there are significant variations in practice across the UK with regards to radiological investigations performed, safeguarding referrals, assessments, and follow up. Methods All hospitals within the PERUKI network were invited to submit data. The study population were children under 2 years who presented to the emergency department and underwent radiological investigation for a suspected skull fracture. Retrospective data was collected for presentations between January 2012 to December 2014 inclusive. Data was collected on the purported mechanisms for the injury, clinical findings, the investigative processes undertaken and subsequent follow-up. Preliminary results 20 UK emergency departments submitted data. Data was collected for 1583 infants who underwent radiological imaging for a suspected skull fracture. 478 of these (30%) had a confirmed skull fracture. 107 (7%) had a likely or definite cause of NAI. Data analysis is ongoing; by February 2018 we will have results of variations in practice across the UK, demographics on event information, symptoms, signs, investigation results of children investigated for skull fractures, and statistical differences in the subgroups of ‘no fractures found’, ‘fractures’, and ‘fractures likely caused by NAI’. Conclusion This study will create an extensive database of children less than 2 years old presenting to emergency departments that were investigated for skull fractures. The study aims to produce evidence to inform guidance, enhance clinical decision making in determining the likelihood of skull fractures being found, and NAI as the underlying cause for the skull fracture.