NONACCIDENTAL BURNS IN CHILDREN

A retrospective review of five hundred and seven consecutive admission s to a state-wide paediatric burns unit over a three year period was m ade to assess the characteristics of the burn injuries and to see whic h, if;ln). characteristics would help to distinguish accidental burns from burns which were due to abuse or neglect. In 86% of admissions (t he 'accident group') it was considered that the injury was accidental, with no evidence of deliberate injury or gross neglect. Eight percent of admissions (the 'abuse/neglect group`) were referred to the State Department of Community Services for abuse or neglect resulting in the Department becoming involved in the family's management. In six perce nt of cases (the 'concern group') the Unit had concerns that the famil y's emotional or social situation was a significant factor in the chil d's injury, or made further injury more likely and discussed the famil y's situation with the Department, but formal intervention was not und ertaken by the Department. There were no differences between the group s in age or mortality. Children in the 'abuse/neglect' and the 'concer n' groups were more likely to require skin grafting and treatment in t he intensive care unit. They were more likely to come from single pare nt families and were more likely to have burns involving both hands or both legs. There were other distinguishing factors. The incidence of prior notification fur abuse and neglect was four percent for the 'acc ident' group. 14% for the 'concern' group and 46% for the 'abuse/negle ct' group. This is considerably higher in the `concern' and 'abuse/neg lect' groups than the annual state incidence of 1.73% for abuse and ne glect notifications. While the clinical features of a burn may often n ot be helpful in reaching a diagnosis of abuse or neglect as a cause o f the burn, it appears that many children who have non-accidental burn s have also had prior notifications for other types of abuse or neglec t. (C) 1998 Elsevier Science Ltd for ISBI. All rights reserved.