Current guidance for investigating suspected non-accidental injury recommends a repeat skeletal survey after 11–14 days to detect any occult fractures missed on the original X-rays1 .

We investigated the yield when the current guidance is applied in routine practice in Barts Health NHS Trust, which includes three paediatric units and serves a child population of 236 000.

We reviewed 198 cases from January 2016 to September 2020, 174 (88%) patients were less than 2 years old and 133 (67%) were less than 1 year of age. 131 (66%) had a second survey.

The flow chart in figure 1 shows the diagnostic yield at the first and second skeletal survey.

Skeletal survey outcomes. …