Burns and scalds in pre-school children attending accident and emergency: accident or abuse?

Objectives-To assess how frequently and adequately information relating to the possibility of non-accidental injury (NAI) is documented and considered by doctors assessing pre-school children with burns and scalds in the acci dent and emergency (A&E) department, and to determine the effect of introdu cing a routine reminder mechanism into the A&E notes, coupled with an impro ved programme of NAI education and awareness. Methods-The records of 100 pre-school children attending an A&E department with a burn or scald were reviewed against nine pre-determined standards. C hanges in policy were instituted, through a programme of education and the use of a reminder checklist, and the next 100 cases re-audited against the same checklist. Results-Groups one and two were similar in their demographic characteristic s. The reminder checklist was included in 60% of group two notes, and when included was completed in 97%. The child protection register was rarely con sulted. There was a statistically significant increase in recording the fol lowing: time that the injury had occurred, the consistency of the history, the compatibility of the injury with the history given, the consideration o f the possibility of NAI, the general state and behaviour of the child and the presence or absence of any other injuries. The rate of referral for a f urther opinion regarding the possibility of NAI increased from 0 to 3%, but failed to reach statistical significance. Conclusions-Prevailing awareness and documentation regarding the possibilit y of NAI was found to be poor, but a programme of intervention combining ed ucation and the use of a reminder checklist improved both awareness and doc umentation of NAI, as well as referral rates for further assessment. This s trategy may prove applicable to children of all ages and injury types, redu cing the number of cases of child abuse that are overlooked in the A&E depa rtment.