A systematic review of the features that indicate intentional scalds in children.
BACKGROUND
Most intentional burns are scalds, and distinguishing these from unintentional causes is challenging.


OBJECTIVE
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.
Department of Child Health, Cardiff University, United Kingdom. sabinemaguire@yahoo.co.uk
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Maguire
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Moynihan
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Mann
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Potokar
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Kemp
D000061:Accidents, Home; D000293:Adolescent; D001494:Baths / Q000009:adverse effects; D002056:Burns / Q000175:diagnosis* / Q000209:etiology; D002081:Buttocks / Q000293:injuries; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D005121:Extremities / Q000293:injuries; D005260:Female; D006801:Humans; D007101:Immersion / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D010502:Perineum / Q000293:injuries