Utility of Hair Toxicology in Detecting Child Abuse or Neglect in the Burn Unit: A Quality Improvement Project

Children represent 20% of all burn admissions annually; 20%-30% are related to abuse or neglect. Our institution's Child Protective Services recently decided to stop following and interpreting hair toxicology results for pediatric patients with burn injuries. Drug use/exposure is an important risk factor for child abuse/neglect. The goal of this study was to evaluate the value of hair toxicology testing to identify child abuse or neglect. Medical records of pediatric patients ≤14 years admitted between January 1, 2019 and February 29, 2024 were reviewed. Demographics, burn injury information, suspicion of child abuse/neglect on admission, routine urine drug screening tests, hair toxicology results, and reporting to the State Health and Human Services (HHS) were collected. Descriptive statistics were obtained. Univariate analyses were performed to assess the utility of hair toxicology with P < .05 considered significant. Two hundred ninety-eight patients were included; child abuse was suspected in 31.5%; hair toxicology was performed for 75.2% of patients and was positive for 35.7%. Hair toxicology was more likely to be performed when child abuse was suspected on admission (81.9% vs 72.1%, P = .044), and to be positive (40.4% vs 20.6%, P < .001). Suspicion on admission was associated with higher HHS involvement (95.7% vs 24%, P < .001). Health and Human Services was more likely to be involved when hair toxicology was performed (54% vs 24.3%, P < .004) and positive (96.3% vs 28.4%, P < .001). Hair toxicology screening for pediatric patients with burn injuries is still a valuable tool to help clinicians report suspected abuse/neglect not otherwise detected on admission using other tools.