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Characteristics of unintentional scalds

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.

 

Physical features of unintentional scalds

Agents of unintentional scalds

The majority of unintentional scald agents are non-tap water: Comparative studies 1-8

 

  • Hot beverages / liquids pulled off table top / stove or opening the microwave and pulling beverages / liquids out / preparation of convenience foods
  • Water used in cooking

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References

Comparative studies

  1. Bajanowski T, Verhoff MA, Wingenfeld L, Püschel K. Forensische Pädopathologie – Tod nach Verbrühung. Drei Fälle mit sehr unterschiedlichen Kausalbedingungen [German] [Forensic paedopathology – death by scalding. Three cases with very different causal conditions]. Rechtsmedizin. 2007;17(4):218-222 [Abstract from SpringerLink]
  2. Daria S, Sugar NF, Feldman KW, Boos SC, Benton SA, Ornstein A. Into hot water head first: distribution of intentional and unintentional immersion burns. Pediatric Emergency Care. 2004;20(5):302-310 [Pubmed]
  3. Dressler DP, Hozid JL. Thermal injury and child abuse: the medical evidence dilemma. Journal of Burn Care & Rehabilitation. 2001;22(2):180-185 [Pubmed]
  4. 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]
  5. Hobbs CJ. When are burns not accidental? Archives of Disease in Childhood. 1986;61(4):357-361 [Pubmed]
  6. Lowell G, Quinlan K, Gottlieb LJ. Preventing unintentional scald burns: moving beyond tap water. Pediatrics. 2008;122(4):799-804 [Pubmed]
  7. Ojo P, Palmer J, Garvey R, Atweh N, Fidler P. Pattern of burns in child abuse. American Surgeon. 2007;73(3):253-255 [Pubmed]
  8. 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]

Mechanisms of unintentional scalds

  • Unintentional scalds are predominantly spill injuries Comparative studies 1-6
  • Few unintentional scalds are caused by immersion Comparative studies 1-7
  • Children removing hot substances from the microwave Comparative study 6
  • One study highlighted scalds involving children aged 7 to 14 years old, either spilling or supervising younger children who sustained the scalds Comparative study 6
  • There is also a case report of unintentional scalds caused by flowing water  Unintentional alone 1

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References

Comparative studies

  1. Ayoub C, Pfeifer D. Burns as a manifestation of child abuse and neglect. American Journal of Diseases in Children. 1979;133(9):910-914 [Pubmed]
  2. Bajanowski T, Verhoff MA, Wingenfeld L, Püschel K. Forensische Pädopathologie – Tod nach Verbrühung. Drei Fälle mit sehr unterschiedlichen Kausalbedingungen [German] [Forensic paedopathology – death by scalding. Three cases with very different causal conditions]. Rechtsmedizin. 2007;17(4):218-222 [Abstract from SpringerLink]
  3. Daria S, Sugar NF, Feldman KW, Boos SC, Benton SA, Ornstein A. Into hot water head first: distribution of intentional and unintentional immersion burns. Pediatric Emergency Care. 2004;20(5):302-310 [Pubmed]
  4. Dressler DP, Hozid JL. Thermal injury and child abuse: the medical evidence dilemma. Journal of Burn Care & Rehabilitation. 2001;22(2):180-185 [Pubmed]
  5. Hobbs CJ. When are burns not accidental? Archives of Disease in Childhood. 1986;61(4):357-361 [Pubmed]
  6. Lowell G, Quinlan K, Gottlieb LJ. Preventing unintentional scald burns: moving beyond tap water. Pediatrics. 2008;122(4):799-804 [Pubmed]
  7. 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]

Unintentional alone studies

  1. Titus MO, Baxter AL, Starling SP. Accidental scald burns in sinks. Pediatrics. 2003;111(2):e191-e194 [Pubmed]

Distribution of unintentional scalds

Key areas which are vulnerable to unintentional scalds are: Comparative studies 1,2 Unintentional alone 1

  • Head, neck and trunk
  • Face and upper body

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References

Comparative studies

  1. Bajanowski T, Verhoff MA, Wingenfeld L, Püschel K. Forensische Pädopathologie – Tod nach Verbrühung. Drei Fälle mit sehr unterschiedlichen Kausalbedingungen [German] [Forensic paedopathology – death by scalding. Three cases with very different causal conditions]. Rechtsmedizin. 2007;17(4):218-222 [Abstract from SpringerLink]
  2. Hobbs CJ. When are burns not accidental? Archives of Disease in Childhood. 1986;61(4):357-361 [Pubmed]

Unintentional alone studies

  1. Sheridan RL. Recognition and management of hot liquid aspiration in children. Annals of Emergency Medicine. 1996;27(1):89-91 [Pubmed]

Patterns of unintentional scalds

  • Lack of circumferential (glove or stocking) distribution Comparative studies 1,3 Unintentional alone 1
  • Irregular margin Comparative studies 1,3 Unintentional alone 1
  • Irregular burn depth Comparative studies 1,3 Unintentional  alone 1
  • Asymmetric involvement Comparative studies 1,2,3 Unintentional alone 1
  • Over 80% were anterior, unilateral Comparative studies 2

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References

Comparative studies

  1. Dressler DP, Hozid JL. Thermal injury and child abuse: the medical evidence dilemma. Journal of Burn Care & Rehabilitation. 2001;22(2):180-185 [Pubmed]
  2. 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]
  3. Yeoh C, Nixon JW, Dickson W, Kemp A, Sibert JR. Patterns of scald injuries. Archives of Disease in Childhood. 1994;71(2):156-158 [Pubmed]

Accidental alone studies

  1. Titus MO, Baxter AL, Starling SP. Accidental scald burns in sinks. Pediatrics. 2003;111(2):e191-e194 [Pubmed]

Features of unintentional flowing water injuries

A single high ranked (A) unintentional study recreated the scene of the accident and confirmed the clinical features found when a child accidentally turns on a hot tap scalding themselves 1

 

Pattern:

  • Lack of circumferential (stocking) distribution
  • Irregular margin
  • Irregular burn depth
  • Lack of splash marks.  However a comparative study did not show any difference in splash marks between intentional and unintentional scalds 2

 

Distribution:

  • Asymmetric involvement of lower limbs

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References

Unintentional alone studies

  1. Titus MO, Baxter AL, Starling SP. Accidental scald burns in sinks. Pediatrics. 2003;111(2):e191-e194 [Pubmed]
  2. 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]

 

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