R. P. Barker1, K. B. Savoie2, R. C. Passaro1, J. W. Eubanks2, R. F. Williams2 1Univeristy Of Tennessee Health Science Center,College Of Medicine,Memphis, TN, USA 2Univeristy Of Tennessee Health Science Center,Department Of General Surgery And Pediatrics,Memphis, TN, USA
Introduction:
Non-accidental burns account for up to 20% of all non-accidental trauma and have been associated with increased septic complications, longer lengths of stay, more operations, and higher morbidity. Identification of these burns can be difficult; therefore, we sought to identify risk factors associated with non-accidental burns.
Methods:
After institutional review board approval, a retrospective chart study of all patients from 2011-2013 with confirmed or suspected diagnoses of non-accidental burns were identified through the institutional trauma data bank. These patients were then matched 2:1 with burn patients who had no suspicion for abuse based on gender, race, TBSA, and date of burn. Individual charts were reviewed and data was abstracted for basic demographics, injury characteristics, and parameters related to non-accidental trauma. Standard statistical analysis was performed.
Results:
A total of 94 patients were identified; 33 of these were either suspected or confirmed non-accidental cases. The remaining 61 were burn cases with no suspicion for abuse. Non-accidental cases presented at younger ages than accidental cases (median age 1.89 vs 8.42, p <0.0001) and were more likely to present with clinical signs of shock (median SBP 101 vs 124, p = 0.0004, median HR 133 vs 103, p = 0.004, median RR 28 vs 22, p = 0.001). Non-accidental cases were more likely to require ICU admissions (32% vs 7%, p = 0.05). Hospital length of stay was longer for non-accidental cases compared to accidental cases (median days 3 vs. 0, p <0.0001). A surgery consultation was required for 87.9% of non-accidental cases vs. 50.8% of accidental cases (p <0.0004). Non-accidental cases were more likely to involve the perineum (36.4% vs. 8.2%, p =0.0007) and the feet (42.4% vs. 14.8%, p =0.0033) when compared to accidental burns. Accidental burns were more likely to involve the upper extremities (37.7% vs. 18.2%, p =0.05) compared to non-accidental burns. While only 47.5% of accidental cases required admission, 93.9% of non-accidental cases were admitted (p <0.0001). Non-accidental cases were more likely to have underlying social concerns when compared to accidental cases. These included a single parent (45.5% vs. 21.7%, p =0.02) and a previous Department of Children Services (DCS) encounter (27.3% vs. 1.7%, p <0.0001). Trauma activation was initiated in 24% of non-accidental cases and none of the accidental matched cases (p <0.0001).
Conclusion:
Suspected and confirmed non-accidental burn cases are overall more severe than accidental burn cases and require more hospital resources. Younger patients with burns to the perineum or feet who live in a single parent home or have a previous DCS encounter are at increased risk for non-accidental burns and may benefit from early social work consultation or transfer to a burn center for further evaluation.