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Effect of a screening profile on the diagnosis of nonaccidental burns in children
Insights
A checklist identifying factors associated with abusive burns significantly increased recognition and reporting by emergency physicians. This led to more effective social service referrals for pediatric burn abuse cases.
Area of Science:
- Pediatric Emergency Medicine
- Child Abuse Recognition
- Medical Interventions
Background:
- Burn injuries in children can be accidental or abusive.
- Accurate identification and reporting of abusive burns are crucial for child protection.
- Emergency physicians play a key role in the initial assessment of burn injuries.
Purpose of the Study:
- To evaluate if increased physician awareness of abusive burn indicators improves recognition and reporting.
- To assess the impact of a standardized checklist on social service referrals for suspected child abuse.
Main Methods:
- A retrospective chart review of burn patients in a pediatric emergency department.
- Implementation of a checklist of abusive burn factors for emergency physicians.
- Prospective data collection on referrals and verified abuse cases post-intervention.
Main Results:
- Reporting of burns to social services increased from 3% to 12.1% after checklist implementation.
- Social service interventions for burn victims rose from 1% to 7.4%.
- The rate of substantiated child abuse cases among reported burns increased.
Conclusions:
- A checklist effectively enhances emergency physicians' recognition and reporting of abusive burns.
- The intervention improved the rate of appropriate social service referrals for pediatric burn abuse.
- Standardized tools can improve the detection and management of child abuse in emergency settings.
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 subsequent intervention.
Setting:
An urban pediatric emergency department (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 service. We then determined whether or not the department of social service, after completion of their investigation, "verified" that abuse had 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 factors associated with abusive burns into the history and physical examination of all burn victims presenting to the ED. Changes in overall referrals to the department of social service as well as in the numbers of cases in which abuse were verified or services offered were then determined.
Results:
Prior to any intervention, 3% (3/87) of burns presenting to the ED from 1990 to 1991 were reported to the department of social service. This contrasted with 12.1% (26/215) of burns presenting after introduction of the checklist. Burn victims, 1/87 (1%), in the retrospective study and 16/215 (7.4%) burn victims in the prospective study received social service intervention after a report was initiated by the ED staff (P < .002). Burn injuries 1/87 (1%) and 7/215 (3.3%), reported during the two studies were substantiated as abusive by social services.
Conclusion:
We conclude that the use of the checklist increased effective social service referral for burn abuse.
