Raising suspicion of maltreatment from burns: Derivation and validation of the BuRN-Tool☆
Section snippets
Table of contents summary
The BuRN-Tool: a novel clinical prediction tool for the emergency room to identify cases of maltreatment in children who have sustained a burn.
What’s known on this subject
A proportion of children with medically attended burns will have sustained their injuries from child neglect or physical abuse. These children are assessed by clinicians with varying pediatric experience and underlying maltreatment may go unrecognized.
What this study adds
A clinical prediction tool, derived from research evidence and primary epidemiologic data, and validated prospectively on a novel dataset, has the potential to raise suspicion of maltreatment associated with pediatric burns and be an adjunct to clinical decision-making.
Derivation
To derive the CPT we used data from a prospective multicenter study of children presenting with a burn to two pediatric EDs, three general EDs and three burns units in the UK and Ireland during 2008–2010 [16]. Children less than 16 years old were included; victims of household fires were excluded. A standardized data collection proforma, the Burns and Scalds Assessment Template (Supplementary Fig. S1), was completed by the treating clinician, recording: age, gender, gross motor developmental
Ascertainment and demographics
A total of 1484 cases were identified, 157 were excluded due to double counting or failure to fulfil the inclusion criteria, leaving 1327 cases; 768 (58%) were scalds (median age; 1 year [IQR 1–3]) and 559 (42%) non-scalds (median age; 2 years [IQR 1–8]). Gender ratio (Male:Female) was 3:2. A total of 8.4% (112/1327; 7.7% for scalds and 9.5% for non-scalds) cases were referred to a children’s social care team. Data completeness for scald cases included in the analyses was 99.6% (765/768) and
Discussion
The BuRN-Tool is an easily completed CPT with the potential to identify which children with burns warrant further child abuse evaluation. The performance of the BuRN-Tool was prospectively validated against a novel dataset to that used for derivation. Although not perfect, the performance of the BuRN-Tool was satisfactory in both derivation and validation and performed slightly better in the validation study with a sensitivity and specificity around 80%.
The strengths of this study are that a
Conclusion
The BuRN-Tool is a prospectively derived level 3 (highest evidence-based standard of validation) CPT [11], [25], with satisfactory accuracy, that has been developed from research evidence and validated prospectively. The items are basic clinical features and the scoring is straight forward; together with the BaSAT it has the potential to act as an ‘aide memoire’ to standardize the assessment of children with burns across multiple professionals in busy emergency settings, and identify those who
Contributors’ statement
Alison Kemp and Sabine Maguire conceptualized, designed, managed and supervised the derivation and validation phase of the study, designed the data collection instruments, and coordinated and supervised data collection at the validation sites, wrote the study manuscript final versions.
Linda Hollén completed the statistical analyses, drafted the initial manuscript and coordinated the final version.
Alan Emond directed the research network, chaired and advised research team meetings, co- ordinated
Funding source
This study was supported by the Scar Free Foundation, and the Health and Care Research Wales. The Children’s Burns Research Centre is part of the Burns Collective, a Scar Free Foundation initiative with additional funding from Vocational Training Charitable Trust and Health and Care Research Wales.
Financial disclosure
The authors have indicated they have no financial relationships relevant to this article to disclose.
Conflict of interest
The authors have no potential conflicts of interest to disclose.
Acknowledgements
The authors wish to thank everyone who contributed data to this study. The participating EDs and units and lead clinicians were:
Derivation study: Cardiff University/Cardiff and Vale University Hospital Board, Wales (Z Lawson, H Dowd, D Farrell), Birmingham Childrens Hospital, England (G DeBelle, C Thomas), Royal Gwent Hospital, Newport, Wales (A Rawlinson, S Jones, J Probert), Morriston Hospital, Swansea, Wales (T Potokar, P Thompson, A McNab), Our Lady’s Hospital for Sick Children, Crumlin,
References (32)
- et al.
Epidemiology and screening of intentional burns in children in a Dutch burn centre
Burns
(2016) - et al.
Non-accidental burns in children — are we neglecting neglect?
Burns
(2006) - et al.
Methodologic standards for interpreting clinical decision rules in emergency medicine: 2014 update
Ann Emerg Med
(2014) - et al.
A systematic review of the features that indicate intentional scalds in children
Burns
(2008) - et al.
Evidence-based emergency medicine/skills for evidence-based emergency care. Interval likelihood ratios: another advantage for the evidence-based diagnostician
Ann Emerg Med
(2003) - et al.
Research electronic data capture (REDCap) — a metadata-driven methodology and workflow process for providing translational research informatics support
J Biomed Inform
(2009) - et al.
The Parkland Burn Center experience with 297 cases of child abuse from 1974 to 2010
Burns
(2016) Home and Leisure Accident Surveillance System (HASS and LASS) data
(2002)- American Burn Association. ABA National Burn Repository....
- et al.
Pattern of burns in child abuse
Am Surg
(2007)
Patient and injury characteristics, mortality risk, and length of stay related to child abuse by burning: evidence from a national sample of 15,802 pediatric admissions
Ann Surg
Factors related to child maltreatment in children presenting with burn injuries
J Burn Care Res
Performance of screening tests for child physical abuse in accident and emergency departments
Health Technol Assess
Children Act 2004 (c.31)
Framework for the impact analysis and implementation of Clinical Prediction Rules (CPRs)
BMC Med Inform Decis Mak
Implementation of clinical decision rules in the emergency department
Acad Emerg Med
Cited by (0)
- ☆
The research team are all members of the Scar Free Foundation Centre for Children’s Burns Research.