Study objective: To determine if awareness of factors associated with
burn abuse increases recognition and reporting by emergency physicians
. Design: The study consisted of a retrospective chart review and a su
bsequent intervention, Setting: An urban pediatric emergency departmen
t (ED), Participants: All patients with the diagnosis of burn seen in
the ED, Intervention: The retrospective chart review (October 1, 1990,
to September 30, 1991) determined the number of patients seen in the
ED, diagnosed with burns, and reported to the department of social ser
vice, We then determined whether or not the department of social servi
ce, after completion of their investigation, ''verified'' that abuse h
ad occurred, In addition, other services provided to the family by the
department of social services were determined, The prospective study
(April 1, 1992, to March 30, 1993) introduced a checklist of 13 factor
s associated with abusive burns into the history and physical examinat
ion of all burn victims presenting to the ED, Changes in overall refer
rals to the department of social service as well as in the numbers of
cases in which abase were verified or services offered were then deter
mined, Results: Prior to any intervention, 3% (3/87) of burns presenti
ng to the ED from 1990 to 1991 were reported to the department of soci
al service. This contrasted with 12.1% (26/215) of burns presenting af
ter introduction of the checklist, Burn victims, 1/87 (1%), in the ret
rospective study and 16/215 (7.4%) burn victims in the prospective stu
dy received social service intervention after a report was initiated b
y the ED staff (P<.002). Burn injuries 1/87 (1%) and 7/215 (3.3%), rep
orted during the two studies were substantiated as abusive by social s
ervices, Conclusion: We conclude that the use of the checklist increas
ed effective social service referral for burn abuse.