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Burns

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

Review last updated March 2015

Although there is increasing research into childhood burns presenting to emergency departments, unfortunately these studies either do not consider maltreatment as an aetiology or fail to offer adequate detail on cases to merit inclusion in the systematic review. Only one new study merited inclusion in this update, however it is a large scale study encompassing scalds and burns 1.

 

The prevalence of abusive burns is estimated to be 10% – 14% of children admitted to burns units 2,3,  highest for those aged 0 – 1 years 4. The outcome for abused children with burns is worse in relation to the need for grafting or intensive care 5. Among children with abusive burns, 16.3% are noted to have fractures and less than 10% have co-existent abusive head trauma or abdominal injury 6.The challenge is to distinguish intentional burns from unintentional burns and also to recognise other skin conditions which may mimic burns. Toxicology screening can be of value to identify illicit drug exposure in children presenting with a burn 3. One study suggests that 14.3% of children presenting with burns suspected to be due to abuse had a positive illicit drug screening 7.

 

We found high quality evidence to aid in distinguishing intentional and unintentional scalds. Contact and caustic burns may not require hospital admission but may lead to significant morbidity and mortality 8. We have examined the features found in intentional non-scald burns, including cultural practices e.g. moxibustion. Cigarette burns are often recorded as abusive injuries. Text books offer clinically distinguishable characteristics for intentional and unintentional cigarette burns and this review has examined the evidence for these statements 9.

 

It has been noted that children less than three years of age sustaining burns have a higher risk of further abuse or neglect by age six years 10.

 

More boys than girls sustain both abusive and unintentional burns 3,11.

 

Burns have been noted more frequently amongst asylum seekers in Western Europe 12.

 

 

The review seeks to answer the following review questions:

  1. What are the clinical and social features that distinguish intentional and accidental scalds in children?
  2. What are the features of intentional non-scald burns?
  3. What conditions mimic intentional burns?
  4. How do you identify a burn due to neglect?*

* To date, there are no studies which address this question

 

Following the 2009 update, we no longer review conditions which mimic burns, and any new studies that we identify on this topic will be found under the other useful references page for this question. However we are seeking to explore the characteristics of burns due to neglect; this search has been run from 2011 onwards.

 

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References

    1. Wibbenmeyer L, Liao J, Heard J, Kealey L, Kealey G, Oral R. Factors related to child maltreatment in children presenting with burn injuries. Journal of Burn Care & Research. 2014;35(5):374-381 [Pubmed]

    2. Chester DL, Jose RM, Aldlyami E, King H, Moiemen NS. Non-accidental burns in children - are we neglecting neglect? Burns. 2006;32(2):222-228 [Pubmed]
    3. Hayek SN, Wibbenmeyer LA, Kealey LDH, Williams IM, Oral R, Onwuameze O, Light TD, Latenser BA, Lewis RW 2nd, Kealey GP. The efficacy of hair and urine toxicology screening on the detection of child abuse by burning. Journal of Burn Care and Research. 2009;30(4):587-592 [Pubmed]
    4. Shah A, Suresh S, Thomas R, Smith S. Epidemiology and profile of pediatric burns in a large referral center. Clinical Pediatrics. 2011;50(5):391-395 [Pubmed]

    5. Montrey JS, Barcia PJ. Nonaccidental burns in child abuse. Southern Medical Journal. 1985;78(11):1324-1326 [Pubmed]
    6. Degraw M, Hicks RA, Lindberg D. Incidence of fractures among children with burns with concern regarding abuse. Pediatrics. 2010;125(2):e295-e299 [Pubmed]

    7. Oral R, Bayman L, Assad A, Wibbenmeyer L, Buhrow J, Austin A, Bayman EO. Illicit drug exposure in patients evaluated for alleged child abuse and neglect. Pediatric Emergency Care. 2011;27(6):490-495 [Pubmed]

    8. Greenbaum AR, Donne J, Wilson D, Dunn KW. Intentional burn injury: an evidence-based, clinical and forensic review. Burns. 2004;30(7):628-642 [Pubmed]
    9. Heaton PA. The pattern of burn injuries in childhood. New Zealand Medical Journal. 1989;102(879):584-586 [Pubmed]
    10. James-Ellison M, Barnes P, Maddocks A, Wareham K, Drew P, Dickson W, Lyons RA, Hutchings H. Social health outcomes following thermal injuries: a retrospective matched cohort study. Archives of Disease in Childhood. 2009;94(9):663-667 [Pubmed]
    11. Ofodile F, Norris J, Garnes A. Burns and child abuse. The East African Medical Journal. 1979;56(1):26-29 [Pubmed citation only]
    12. Dempsey MP, Orr DJA. Are paediatric burns more common in asylum seekers? An analysis of paediatric burn admissions. Burns. 2006;32(2):242-245 [Pubmed]

 

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