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A Comparison Study of Accidental versus Nonaccidental Pediatric Thermal Injury
Farah Brink, MD1; Kristin Crichton, DO, MPH2; Krista Wheeler, MS3; Junxin Shi3; Henry Xiang, MD, MPH, PhD3; Andrew Nordin, MD2; Rajan Thakkar, MD2
1Nationwide Children's Hospital, Dublin, OH; 2Nationwide Children's Hospital, Columbus, OH; 3The Research Institute at Nationwide Children's Hospital, Columbus, OH

Background: Intentional burns represent a significant form of child maltreatment. The patient and burn characteristics of children ≤5 years of age admitted to an American Burn Association verified pediatric burn center were evaluated. We determined the likelihood of abuse and neglect.

Methods: A retrospective study was conducted using our trauma registry, child protection team database, and electronic medical record to identify thermally injured patients ≤5 years of age admitted from October 2008-May 2017. Associations and clinical outcomes were evaluated using Chi square analyses.

Results: Of 993 patients admitted for burns, 36 (3.6%) were determined to be due to physical abuse and 31 (3.1%) were due to neglect. No significant differences were found in the sex, age, race, and total body surface area burned between the accidental and abuse/neglect group. However, children with burns due to abuse or neglect were significantly more likely to have full thickness burns (p=0.003), injuries to the right or left buttocks (p=0.0047 and p=0.0140, respectively) or genitalia (p<0.0001), higher injury severity scores (p=0.0079), comorbid injuries (p<0.0001), and require intensive care unit admission (p=0.0046). A higher proportion of children with burns due to abuse or neglect had public insurance (p <0.0001).

Conclusions: In a large cohort of children with burns, those due to abuse or neglect were more likely to have burns to their buttocks/genitalia, deeper burns, comorbid injuries and be publically insured. Awareness of demographic and injury patterns in children with burns due to abuse and neglect is crucial in ensuring the safety of these children.

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