Influence of agents and mechanisms of injury on anatomical burn locations in children <5 years old with a scald

Abstract

Objective: To demonstrate how the mechanism and agent of injury can influence the anatomical location of a scald.

Design: Prospective multicentre cross-sectional study.

Setting: 20 hospital sites across England and Wales including emergency departments, minor injury units and regional burns units.

Patients: Children aged 5 years and younger who attended hospital with a scald.

Main outcome measures: Primary outcome: a descriptive analysis of the mechanism, agent and anatomical location of accidental scalds. Secondary outcome: a comparison of these factors between children with and without child protection (CP) referral.

Results: Of 1041 cases of accidental scalds, the most common narrative leading to this injury was a cup or mug of hot beverage being pulled down and scalding the head or trunk (132/1041; 32.9% of cases). Accidental scalds in baths/showers were rare (1.4% of cases). Accidental immersion injuries were mainly distributed on hands and feet (76.7%). There were differences in the presentation between children with accidental scalds and the 103 who were referred for CP assessment; children with scalds caused by hot water in baths/showers were more likely to get referred for CP assessment (p<0.0001), as were those with symmetrically distributed (p<0.0001) and unwitnessed (p=0.007) scalds.

Conclusions: An understanding of the distributions of scalds and its relationship to different mechanisms of injury and causative agents will help clinicians assess scalds in young children, particularly those new to the emergency department who may be unfamiliar with expected scald patterns or with the importance of using appropriate terminology when describing scalds.

Keywords: child abuse; epidemiology.