The Parkland Burn Center experience with 297 cases of child abuse from 1974 to 2010

Erica I. Hodgman, Rachel A. Pastorek, Melody R. Saeman, Michael W. Cripps, Ira H. Bernstein, Steven Wolf, Karen J. Kowalske, Brett D. Arnoldo, Herb A. Phelan

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Introduction Pediatric burns due to abuse are unfortunately relatively common, accounting for 5.8–8.8% of all cases of abuse annually. Our goal was to evaluate our 36-year experience in the evaluation and management of the victims of abuse in the North Texas area. Methods A prospectively maintained database containing records on all admissions from 1974 through 2010 was queried for all patients aged less than 18 years. Patients admitted for management of a non-burn injury were excluded from the analysis. Results Of 5,553 pediatric burn admissions, 297 (5.3%) were due to abuse. Children with non-accidental injuries tended to be younger (2.1 vs. 5.0 years, p < 0.0001) and male (66.0 vs. 56.5%, p = 0.0008). Scald was the most common mechanism of injury overall (44.8%), and was also the predominant cause of inflicted burns (89.6 vs. 42.3%, p < 0.0001). Multivariate logistic regression identified age, gender, presence of a scald, contact, or chemical burn, and injury to the hands, bilateral feet, buttocks, back, and perineum to be significant predictors of abuse. Victims of abuse were also found to have worse outcomes, including mortality (5.4 vs. 2.3%, p = 0.0005). After adjusting for age, mechanism of injury, and burn size, abuse remained a significant predictor of mortality (OR 3.3, 95% CI 1.5–7.2) Conclusions Clinicians should approach all burn injuries in young children with a high index of suspicion, but in particular those with scalds, or injuries to the buttocks, perineum, or bilateral feet should provoke suspicion. Burns due to abuse are associated with worse outcomes, including length of stay and mortality.

Original languageEnglish (US)
Pages (from-to)1121-1127
Number of pages7
JournalBurns
Volume42
Issue number5
DOIs
StatePublished - Aug 1 2016
Externally publishedYes

Fingerprint

Burn Units
Child Abuse
Wounds and Injuries
Burns
Perineum
Buttocks
Mortality
Foot
Chemical Burns
Pediatrics
Hand Injuries
Length of Stay
Logistic Models
Databases

Keywords

  • Abuse
  • Burn
  • Epidemiology
  • Non-accidental trauma
  • Pediatric

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Hodgman, E. I., Pastorek, R. A., Saeman, M. R., Cripps, M. W., Bernstein, I. H., Wolf, S., ... Phelan, H. A. (2016). The Parkland Burn Center experience with 297 cases of child abuse from 1974 to 2010. Burns, 42(5), 1121-1127. https://doi.org/10.1016/j.burns.2016.02.013

The Parkland Burn Center experience with 297 cases of child abuse from 1974 to 2010. / Hodgman, Erica I.; Pastorek, Rachel A.; Saeman, Melody R.; Cripps, Michael W.; Bernstein, Ira H.; Wolf, Steven; Kowalske, Karen J.; Arnoldo, Brett D.; Phelan, Herb A.

In: Burns, Vol. 42, No. 5, 01.08.2016, p. 1121-1127.

Research output: Contribution to journalArticle

Hodgman, EI, Pastorek, RA, Saeman, MR, Cripps, MW, Bernstein, IH, Wolf, S, Kowalske, KJ, Arnoldo, BD & Phelan, HA 2016, 'The Parkland Burn Center experience with 297 cases of child abuse from 1974 to 2010', Burns, vol. 42, no. 5, pp. 1121-1127. https://doi.org/10.1016/j.burns.2016.02.013
Hodgman EI, Pastorek RA, Saeman MR, Cripps MW, Bernstein IH, Wolf S et al. The Parkland Burn Center experience with 297 cases of child abuse from 1974 to 2010. Burns. 2016 Aug 1;42(5):1121-1127. https://doi.org/10.1016/j.burns.2016.02.013
Hodgman, Erica I. ; Pastorek, Rachel A. ; Saeman, Melody R. ; Cripps, Michael W. ; Bernstein, Ira H. ; Wolf, Steven ; Kowalske, Karen J. ; Arnoldo, Brett D. ; Phelan, Herb A. / The Parkland Burn Center experience with 297 cases of child abuse from 1974 to 2010. In: Burns. 2016 ; Vol. 42, No. 5. pp. 1121-1127.
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abstract = "Introduction Pediatric burns due to abuse are unfortunately relatively common, accounting for 5.8–8.8{\%} of all cases of abuse annually. Our goal was to evaluate our 36-year experience in the evaluation and management of the victims of abuse in the North Texas area. Methods A prospectively maintained database containing records on all admissions from 1974 through 2010 was queried for all patients aged less than 18 years. Patients admitted for management of a non-burn injury were excluded from the analysis. Results Of 5,553 pediatric burn admissions, 297 (5.3{\%}) were due to abuse. Children with non-accidental injuries tended to be younger (2.1 vs. 5.0 years, p < 0.0001) and male (66.0 vs. 56.5{\%}, p = 0.0008). Scald was the most common mechanism of injury overall (44.8{\%}), and was also the predominant cause of inflicted burns (89.6 vs. 42.3{\%}, p < 0.0001). Multivariate logistic regression identified age, gender, presence of a scald, contact, or chemical burn, and injury to the hands, bilateral feet, buttocks, back, and perineum to be significant predictors of abuse. Victims of abuse were also found to have worse outcomes, including mortality (5.4 vs. 2.3{\%}, p = 0.0005). After adjusting for age, mechanism of injury, and burn size, abuse remained a significant predictor of mortality (OR 3.3, 95{\%} CI 1.5–7.2) Conclusions Clinicians should approach all burn injuries in young children with a high index of suspicion, but in particular those with scalds, or injuries to the buttocks, perineum, or bilateral feet should provoke suspicion. Burns due to abuse are associated with worse outcomes, including length of stay and mortality.",
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AU - Pastorek, Rachel A.

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AU - Bernstein, Ira H.

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AU - Kowalske, Karen J.

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N2 - Introduction Pediatric burns due to abuse are unfortunately relatively common, accounting for 5.8–8.8% of all cases of abuse annually. Our goal was to evaluate our 36-year experience in the evaluation and management of the victims of abuse in the North Texas area. Methods A prospectively maintained database containing records on all admissions from 1974 through 2010 was queried for all patients aged less than 18 years. Patients admitted for management of a non-burn injury were excluded from the analysis. Results Of 5,553 pediatric burn admissions, 297 (5.3%) were due to abuse. Children with non-accidental injuries tended to be younger (2.1 vs. 5.0 years, p < 0.0001) and male (66.0 vs. 56.5%, p = 0.0008). Scald was the most common mechanism of injury overall (44.8%), and was also the predominant cause of inflicted burns (89.6 vs. 42.3%, p < 0.0001). Multivariate logistic regression identified age, gender, presence of a scald, contact, or chemical burn, and injury to the hands, bilateral feet, buttocks, back, and perineum to be significant predictors of abuse. Victims of abuse were also found to have worse outcomes, including mortality (5.4 vs. 2.3%, p = 0.0005). After adjusting for age, mechanism of injury, and burn size, abuse remained a significant predictor of mortality (OR 3.3, 95% CI 1.5–7.2) Conclusions Clinicians should approach all burn injuries in young children with a high index of suspicion, but in particular those with scalds, or injuries to the buttocks, perineum, or bilateral feet should provoke suspicion. Burns due to abuse are associated with worse outcomes, including length of stay and mortality.

AB - Introduction Pediatric burns due to abuse are unfortunately relatively common, accounting for 5.8–8.8% of all cases of abuse annually. Our goal was to evaluate our 36-year experience in the evaluation and management of the victims of abuse in the North Texas area. Methods A prospectively maintained database containing records on all admissions from 1974 through 2010 was queried for all patients aged less than 18 years. Patients admitted for management of a non-burn injury were excluded from the analysis. Results Of 5,553 pediatric burn admissions, 297 (5.3%) were due to abuse. Children with non-accidental injuries tended to be younger (2.1 vs. 5.0 years, p < 0.0001) and male (66.0 vs. 56.5%, p = 0.0008). Scald was the most common mechanism of injury overall (44.8%), and was also the predominant cause of inflicted burns (89.6 vs. 42.3%, p < 0.0001). Multivariate logistic regression identified age, gender, presence of a scald, contact, or chemical burn, and injury to the hands, bilateral feet, buttocks, back, and perineum to be significant predictors of abuse. Victims of abuse were also found to have worse outcomes, including mortality (5.4 vs. 2.3%, p = 0.0005). After adjusting for age, mechanism of injury, and burn size, abuse remained a significant predictor of mortality (OR 3.3, 95% CI 1.5–7.2) Conclusions Clinicians should approach all burn injuries in young children with a high index of suspicion, but in particular those with scalds, or injuries to the buttocks, perineum, or bilateral feet should provoke suspicion. Burns due to abuse are associated with worse outcomes, including length of stay and mortality.

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