RETURN TO JEOPARDY - THE FATE OF PEDIATRIC BURN PATIENTS WHO ARE VICTIMS OF ABUSE AND NEGLECT

Child abuse and neglect continue to account for a significant number o f pediatric burn injuries. Although the epidemiology of intentional bu rn injuries has been studied, this report compares victims of abuse wi th victims of neglect. Furthermore, we investigate the long-term fate of both victim and perpetrator. A retrospective search of the North Ca rolina Jaycee Burn Center database identified 21 abuse and 21 neglect patients among 238 pediatric admissions (mean age 5.4 years, mean surf ace area 14%) from 1992 to 1994. The medical, social, and legal record s of each patient were examined by two independent reviewers. History, hospital course, and disposition were compared between groups by chi- square analysis and Student's t test. Compared with victims of neglect , abused children were slightly younger (2.1 vs 2.7 years), had somewh at larger burns (12.3% vs 9.0% total body surface area), had inconsist ent mechanisms of injury (90% vs 33%, p < 0.001) that were bathroom-re lated (81% vs 29%, p < 0.001), were likely to have a history of abuse (57% vs 24%, p < 0.05) or stigmata of abuse on exam (43% vs 14%, p < 0 .05), had longer lengths of stay (23.8 vs 14.1 days, p < 0.05), had si milar complication rates, and were placed more often in foster care (6 5% vs 15%, p < 0.01). Inpatient mortality was 5%. Mean follow-up was 1 08 days, during which time two children were readmitted for repeat abu se. Regarding the caregivers, 57% were single mothers, 36% had been in vestigated for abuse or neglect, and 12% had lost custody of other chi ldren. Of the perpetrators involved in abuse, 71% were charged with a felony, 43% were convicted, and 19% were incarcerated longer than 30 d ays. Victims of burn abuse and neglect differ considerably in terms of history and disposition but not hospital course. Children in both gro ups, however, remain at risk for abuse and neglect after discharge. We recommend that more aggressive efforts be made to secure safe environ ments for these children and that the perpetrator, if clearly identifi ed, be dealt with in a fashion to prevent recurrence of the offense.