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Updated: Dec 10, 2025
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Published on: February 23, 2024
Identifying Abuse and Neglect in Hospitalized Children With Burn Injuries
Hallie J Quiroz1, Joshua P Parreco1, Nima Khosravani2
1Dewitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine, Miami, Florida.
Insights
Child maltreatment is linked to severe burns in children. Identifying undiagnosed abuse is crucial for prevention efforts, especially for burns involving over 20% of the body surface area or lower limbs.
Area of Science:
- Pediatric Emergency Medicine
- Child Abuse and Neglect Research
- Burn Injury Epidemiology
Background:
- Burn injuries in children can be associated with abuse and neglect.
- Understanding injury patterns is vital for identifying maltreatment.
- Early detection of child maltreatment in burn cases is a public health concern.
Purpose of the Study:
- To identify injury patterns associated with child abuse and neglect in pediatric burn admissions.
- To determine the incidence of maltreatment in children with burn injuries.
- To analyze risk factors for readmission due to maltreatment.
Main Methods:
- Utilized the Nationwide Readmissions Database (2010-2014) for pediatric burn admissions (<18 years).
- Defined primary outcome as child maltreatment at index admission and secondary outcome as readmission for maltreatment.
- Employed multivariable logistic regression for outcome analysis, including subgroup analysis for undiagnosed cases.
Main Results:
- 3.4% of pediatric burn admissions (1960 cases) involved maltreatment.
- Maltreatment was significantly associated with extensive burns (>20% total body surface area) and lower limb burns.
- Readmission for maltreatment occurred in 0.2% of cases, with prior maltreatment identification being a strong predictor (OR 5.11).
- In cases without initial maltreatment diagnosis, burns of the eye/ocular adnexa were a significant risk factor for missed maltreatment (OR 3.79).
Conclusions:
- A notable proportion of pediatric burn admissions may involve undiagnosed child maltreatment.
- Identifying children with burn injuries at risk for maltreatment is essential for intervention and prevention.
- Further research into subtle injury patterns may improve the detection of abuse in burn victims.
Background:
The purpose of this study was to identify the pattern of injuries that relates to abuse and neglect in children with burn injuries.
Methods:
The Nationwide Readmissions Database for 2010-2014 was queried for all patients aged less than 18 y admitted with burn injuries. The primary outcome was child maltreatment identified at the index admission. The secondary outcome was readmission for maltreatment. A subgroup analysis was performed on patients without a diagnosis of maltreatment during the index admission. Multivariable logistic regression was performed for each outcome.
Results:
There were 57,939 admissions identified and 1960 (3.4%) involved maltreatment at the index admission. Maltreatment was associated with total body surface area burned >20% (odds ratio (OR) 2.79, P < 0.001) and burn of the lower limbs (OR 1.37, P < 0.001). Readmission for maltreatment was found in 120 (0.2%), and the strongest risk factor was maltreatment identified at the index admission (OR 5.11, P < 0.001). After excluding the patients with maltreatment identified at the index admission, 96 (0.17%) children were found to have a readmission for maltreatment that may have been present on the index admission and subsequently missed. The strongest risk factor was burn of the eye or ocular adnexa (OR 3.79, P = 0.001).
Conclusions:
This study demonstrates that a portion of admissions for burn injuries in children could involve maltreatment that was undiagnosed. Identifying these at-risk individuals is critical to prevention efforts.
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