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

• Scalds are the most common mechanism of injury among abused children.
• Children under the age of 5 are at the highest risk for abuse.
• Injury to the hands, feet, buttocks, back and perineum are predictive of abuse.
• Abused children have larger injuries and worse outcomes, including mortality.
• Abuse remains a predictor of mortality after adjusting for age, %TBSA and mechanism.

IntroductionPediatric 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.MethodsA 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.ResultsOf 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)ConclusionsClinicians 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.