The quality of evidence collected at the child protection medical: The development and pilot testing of infrared, ultraviolet, cross polarisation and high frequency ultrasound to improve standardised collection of bruises.

Evans, Samuel Thomas 2022. The quality of evidence collected at the child protection medical: The development and pilot testing of infrared, ultraviolet, cross polarisation and high frequency ultrasound to improve standardised collection of bruises. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

Summary Introduction. In 2020 the NSPCC reported that an estimated 51,510 children in the UK are known to be at risk of abuse. Bruises are the most common injuries to be seen in cases of suspected physical child abuse. It is recognised that up to a third of children who are fatally abused have been seen by a health professional within the previous three weeks where the significance of subtle injuries such as bruising has been missed. Aims. The aim of this study was to investigate the quality of forensic evidence collected by paediatricians at the child protection medical examination relating to bruises and to investigate the effectiveness of imaging methods of bruises. Methods. Firstly, a questionnaire was sent to members of the Royal College of Paediatricians to determine if reporting guidelines of bruise characteristics were believed to be being followed. Secondly, an analysis of paediatricians’ child medical examination reports at Cardiff and Vale University Health Board performed to determine the level of reporting in this cohort. An improved protocol for bruise reporting with association training was introduced and another analysis of reports was performed to see if this improved reporting standards. Finally, bruises imaging was carried out via standard photography (SP), infra-red (IR), ultraviolent (UV), high-frequency ultrasound (HFUS), and cross polarised (XP) imaging order to find the best method comparatively. Results. Reporting of characteristics of bruises is not 100% in all required categories from the survey of Royal College and the analysis of reports by working paediatricians in Cardiff suggests that it might be much worse in reality. The new proforma and appropriate training did lead to improvement in reporting standards in all categories (P < 0.001), certainly in the short-term. Complex relationships were also seen between the rank, size and shape of bruises as a function of perpetrator, location, implement, age, and gender that were often highly significant statistically (i.e., P < 0.001). IV, UV, and HFUS imaging did not improve effectiveness compared to SP, although XP imaging provided improved bruise definition. Conclusion. The reporting of bruises by paediatricians in the UK is clearly far from perfect, although results for the new proforma and training were encouraging. However, more work is needed to establish if improvements in bruise recording persist in the longer term. Results found here suggest that more work needs also to be carried out to improve methods of bruise imaging, although initial results for XP imaging were encouraging.

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Medicine
Date of First Compliant Deposit:	27 September 2022
Last Modified:	22 Sep 2023 01:30
URI:	https://orca.cardiff.ac.uk/id/eprint/152786

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