Dr E Payne, Dr H Murch & Dr C Woolley Ysbyty Ystrad Fawr Hospital, Aneurin Bevan University Health Board Concerning features (RCPCH Child Protection Companion 2008) Age Doesn’t fit the injury Doesn’t fit with development Inconsistent history Unwitnessed Inappropriate parental response Repeated attendance Known to social services Types of fracture suspicious of abuse (RCPCH Child Protection Companion 2008) Multiple fractures Humeral Rib fractures Femoral fractures (non-mobile child) Spinal fractures Metaphyseal fractures Skull fracture. Audit aims To study fractures seen in children under 3yrs in A&E during 2012-13. To evaluate the documentation & assessment as recommended by RCPCH Child Protection Companion 2008. Method Retrospective analysis of medical records for children under 3 years with fracture presenting to A&E in two Gwent hospitals. N = 106 Age distribution 30 Number of cases 25 20 15 10 5 0 0-0.5 yrs N=106 F 54, M 52. 0.5-1 yrs 1-1.5 yrs 1.5-2 yrs 2-2.5 yrs 2.5-3 yrs Site of fracture 35 Number of cases 30 25 20 15 10 5 0 Risk factors for NAI No mechanism of injury 8.5% Delay in presentation 23% Unwitnessed injury 3.5% Action 6/32 discussed when 1 risk factor 2/9 discussed when 2 risk factors 0/1 discussed when 3 risk factors 1/2 discussed when 4 risk factors Conclusions Adherence to departmental guidelines in 2/3 cases. Lack of recognition of risk factors for NAI. Very few referrals to paediatrics & social services. Opportunities for discussions about NAI are missed. Intervention Mandatory training in Child Protection (e-LFH) for A&E juniors. A&E triggers: A&E database to include red flags for NAI. Paediatric nurse triaging to discuss with A&E senior.