Background: In 2013, the Canadian Pediatric Society (CPS) published recommendations for the clinical evaluation of bruises suspicious for child maltreatment. A thorough assessment is essential given the high stakes medico-legal nature of these cases. Ensuring that every component of the history, physical examination and investigations are obtained and documented remains a challenge. We have developed and implemented a tool to improve the quality of clinical assessments and adherence to published CPS guidelines.

Objectives: Among children (≤ 6 years) being assessed for bruises concerning for child abuse, we aim to increase the completion rate of recommended items documented using a checklist tool to 85% and to have 80% of patients reaching this target. We expect that user acceptability and satisfaction will play an important role in checklist implementation.

Methods: We completed a chart audit to establish baseline documentation of bruising assessments before implementation of this checklist. A checklist tool was developed and implemented within a clinic for the assessment of child maltreatment. The checklist went through multiple revisions to increase acceptability of the tool and satisfaction of users. Following development and implementation of the checklist tool, a repeat chart audit was completed. Outcomes assessed included percentage of each checklist completed and percentage of patients with checklists at least 85% completed, user satisfaction with the checklist tool, and ongoing monitoring for patients “over-investigated” because of checklist as determined by peer review. The first phase of the study was completed in May 2016. Feedback from that phase was reviewed and incorporated into use of this tool. A second phase of the study was completed with repeat chart audits from 2016-2017.

Results: Results from the first phase of the study indicate that, on average, documentation of recommended items increased from 37.4% at baseline to 94.7% after checklist implementation, with an increase from 0% to 100% of checklists reaching an 85% completion rate. The results of the second phase of the study will be discussed as well as challenges to implementation of this tool.

Conclusion: This first phase of the study demonstrated that utilization of this clinical tool improved documentation of bruising assessments. Going forward, we hope to implement multi-center use of this tool for routine clinical assessment of bruising that is concerning for child maltreatment.