EFFECT OF A SCREENING PROFILE ON THE DIAGNOSIS OF NONACCIDENTAL BURNSIN CHILDREN

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.