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A systematic review of the features that indicate intentional scalds in children
S Maguire1, S Moynihan, M Mann
1Department of Child Health, Cardiff University, United Kingdom. sabinemaguire@yahoo.co.uk
Insights
Distinguishing intentional scalds from unintentional ones is difficult. Intentional scalds often present as symmetrical immersion injuries, typically from hot tap water, while unintentional scalds are usually spills with irregular patterns.
Area of Science:
- Pediatric Burn Injury
- Forensic Medicine
- Public Health
Background:
- Differentiating intentional burns (scalds) from unintentional ones is a significant clinical challenge.
- Scalds represent the majority of intentional burn injuries in children.
- Accurate identification is crucial for appropriate intervention and child protection.
Purpose of the Study:
- To systematically review and identify key distinguishing features between intentional and unintentional scalds in children.
- To provide evidence-based characteristics to aid in the differentiation of scald injury origins.
Main Methods:
- Comprehensive literature search across 12 databases (1950-2006) for studies on pediatric scalds.
- Inclusion of primary studies with validated intentional or accidental scalds in children aged 0-18 years.
- Expert review by pediatric/burn specialists using standardized methodology to rank study reliability.
Main Results:
- 26 studies were included from 258 reviewed, with five high-quality comparative studies.
- Intentional scalds: common immersion, hot tap water, symmetrical, clear upper margins, affecting extremities/buttocks/perineum; associated with old fractures/unrelated injuries.
- Unintentional scalds: common spills, other hot liquids, upper body distribution, irregular margins/depth.
Conclusions:
- Distinctive features can help differentiate intentional from unintentional scalds.
- An evidence-based triage tool is proposed to assist clinicians in distinguishing scald origins.
- Prospective validation of the proposed triage tool is recommended.
Background:
Most intentional burns are scalds, and distinguishing these from unintentional causes is challenging.
Aim:
To conduct a systematic review to identify distinguishing features of intentional and unintentional scalds.
Methods:
We performed an all language literature search of 12 databases 1950-2006. Studies were reviewed by two paediatric/burns specialists, using standardised methodology. Included: Primary studies of validated intentional or accidental scalds in children 0-18 years and ranked by confirmation of intentional or unintentional origin. Excluded: neglectful scalds; management or complications; studies of mixed burn type or mixed adult and child data.
Results:
258 studies were reviewed, and 26 included. Five comparative studies ranked highly for confirmation of intentional/unintentional cause of injury. The distinguishing characteristics were defined based on best evidence. Intentional scalds were commonly immersion injuries, caused by hot tap water, affecting the extremities, buttocks or perineum or both. The scalds were symmetrical with clear upper margins, and associated with old fractures and unrelated injuries. Unintentional scalds were more commonly due to spill injuries of other hot liquids, affecting the upper body with irregular margins and depth.
Conclusions:
We propose an evidence based triage tool to aid in distinguishing intentional from unintentional scalds, requiring prospective validation.
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