title: A 6-Year Case-Control Study of the Presentation and Clinical Sequelae for Noninflicted, Negligent, and Inflicted Pediatric Burns.
abstract: Inflicted burns are one of the leading causes of abuse-related fatalities in children. Between 30 and 60% of children accidentally returned to abusive homes suffer reabuse. Given the high chance for abuse recurrence and the associated morbidity/mortality, it is critical that inflicted burns are promptly identified to guide appropriate medical and child welfare management. Although previous studies proposed historical and mechanistic features using noncomparative or poorly powered data, this study utilized comparative data from a 6-year period (2009-2014) at a certified burn center along with expert analysis from Child Advocacy and Protective Services (CAPS) to provide higher level evidence supporting classical findings while elucidating new features with respect to burn severity and required interventions. A retrospective chart review of 408 pediatric burns was cross-referenced with the respective CAPS consultations to construct a multidisciplinary, deidentified database. The average age was 2.9 years (0.04-17 years) with 232 (57%) males and 330 (81%) African-Americans. CAPS investigations confirmed burn etiologies: noninflicted (346 [85%]), negligent (30 [7%]), and inflicted (32 [8%]). In comparing the three etiologies, statistical significance (P < .05) was observed for numerous variables including historical inconsistency, burn age, child welfare history, burn size and depth, distribution, concomitant injury rates, number of surgical interventions, infectious complications, and hospital length of stay. In addition to reaffirming classical features of abusive burns to fortify etiologic diagnoses, this study elucidated appreciable differences in burn severity, interventional sequelae, and burn-related complications, which will help guide medical and surgical interventions for future pediatric burn patients.
authors.affiliation: From the *Pritzker School of Medicine, University of Chicago, Chicago, Illinois; †Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago, Chicago, Illinois; ‡Child Protective Services, Department of Pediatrics, University of Chicago, Chicago, Illinois; and §Burn and Complex Wound Center, Department of Surgery, Univeristy of Chicago, Chicago, Illinois.
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Collier
authors.forename: Veena
authors.initials: V
authors.lastname: Ramaiah
authors.forename: Jill C
authors.initials: JC
authors.lastname: Glick
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Gottlieb
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002053:Burn Units / Q000706:statistics & numerical data*; D002056:Burns / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D016022:Case-Control Studies; D002648:Child; D002649:Child Abuse / Q000517:prevention & control / Q000706:statistics & numerical data*; D002669:Child Welfare; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D008318:Malpractice; D020380:Needs Assessment; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology