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Koenig SM, Deng L, Onwubiko C, Beierle EA, Russell RT. Pediatric Burn Injuries: Risk Factors for Increased Mortality. J Surg Res 2024; 301:584-590. [PMID: 39089134 DOI: 10.1016/j.jss.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/14/2024] [Accepted: 07/07/2024] [Indexed: 08/03/2024]
Abstract
INTRODUCTION Burn injuries are among the top ten leading causes of unintentional death in pediatric patients and are encountered by pediatric surgeons in all practice settings. There is a lack of literature evaluating mortality in pediatric burn injuries in regard to nonaccidental burns and potential disparities. Our study aims to determine the risk factors associated with mortality in pediatric burn injuries and highlight the characteristics of this patient population. METHODS We utilized the Trauma Quality Improvement Program database from 2017 to 2019 to identify primary burn injuries in children ≤14 y old. Physical abuse descriptors were used to identify patients with suspected nonaccidental injuries. Further demographics, including age, race, ethnicity, and insurance type, were evaluated. Descriptive statistics were generated and a multivariable logistic regression analysis was utilized to evaluate risk factors for mortality. RESULTS 13,472 pediatric burn patients (≤14 y old) were identified. The overall mortality was low (<1%). Children with burns to multiple body regions had the highest independent risk of mortality in this cohort. All older age groups had an independent risk of mortality compared to the youngest patients, but those from ages 5 to <10 y old had the highest risk of mortality (OR = 11.40; 95% confidence interval: 4.41-29.43, P < 0.001). Black children had a significantly higher mortality compared to White children. Nonaccidental burns carried a mortality that was twice that of accidental burns. Government insurance type was the primary insurance type for a majority of patients who died. CONCLUSIONS Risk factors for mortality in pediatric burn include Black race, multiple affected body regions, and nonaccidental burns. This study identified an increased mortality risk in the older age groups in contrast to previous studies that showed increased mortality in younger patients suffering from burn injuries.
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Affiliation(s)
- Samantha M Koenig
- Division of Pediatric Surgery, Children's of Alabama, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Luqin Deng
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Chinwendu Onwubiko
- Division of Pediatric Surgery, Children's of Alabama, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth A Beierle
- Division of Pediatric Surgery, Children's of Alabama, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert T Russell
- Division of Pediatric Surgery, Children's of Alabama, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Ina J, Dumaine AM, Flanagan C, Haase L, Moore R, Rimnac C, Gilmore A. Findings Associated With Nonaccidental Trauma in Children With Isolated Femoral Diaphyseal Fractures. J Pediatr Orthop 2024; 44:e717-e721. [PMID: 38813812 DOI: 10.1097/bpo.0000000000002740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Pediatric patients with isolated femoral diaphyseal fractures are difficult to assess for nonaccidental trauma (NAT). The purpose of this study was to determine (1) if there are any demographic features of isolated femoral diaphyseal fractures associated with suspected NAT and (2) if there are clinical signs associated with isolated femoral diaphyseal fractures associated with suspected NAT. METHODS All patients with femoral diaphyseal fractures from January 2010 to June 2018 were reviewed. We included patients younger than 4 years old with isolated femoral diaphyseal fractures. We excluded patients 4 years old and older, polytraumas, motor vehicle collisions, and patients with altered bone biology. Diagnosis of suspected NAT was determined by review of a documented social work assessment. We recorded fracture characteristics including location along femur as well as fracture pattern and presence of associated findings on NAT workup including the presence of retinal hemorrhage, subdural hematoma, evidence of prior fracture, or cutaneous lesions. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these associated findings were calculated. RESULTS Totally, 144 patients met the inclusion criteria. Social work was consulted on 50 patients (35%). Suspected NAT was diagnosed in 27 patients (19%). The average age of patients with suspected NAT was 0.82 and 2.25 years in patients without NAT ( P <0.01). The rate and type of skin lesions present on exam were not different between the 2 groups. Patients with suspected NAT had no findings of retinal hemorrhage or subdural hematoma, but 5 of 27 patients (19%) had evidence of prior fracture on skeletal survey. The sensitivities of retinal hemorrhage, subdural, and skeletal survey were 0%, 0%, and 19% and the specificities of all were 100%. The NPVs were 39%, 27%, and 63%, respectively. The PPV of skeletal survey was 100%. Since there were no patients in this study with positive findings of retinal hemorrhage or subdural hematoma, the PPV for these could not be assessed. CONCLUSIONS In the current study, signs of NAT such as skin lesions, retinal hemorrhage, subdural hematoma, and evidence of prior fracture on skeletal survey may not be helpful to diagnosis suspected NAT in patients with an isolated femoral diaphyseal fracture. LEVEL OF EVIDENCE Level III-diagnostic study.
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Affiliation(s)
- Jason Ina
- Department of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital at University Hospitals Cleveland Medical Center
| | - Anne M Dumaine
- Department of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital at University Hospitals Cleveland Medical Center
| | - Christopher Flanagan
- Department of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital at University Hospitals Cleveland Medical Center
| | - Lucas Haase
- Department of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital at University Hospitals Cleveland Medical Center
| | - Rebecca Moore
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH
| | - Clare Rimnac
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH
| | - Allison Gilmore
- Department of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital at University Hospitals Cleveland Medical Center
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Graner M, Gutierre M, Salgado LS, Mishaly A, Baptista J, Calheiros G, Buda AM, Bowder AN, Corlew DS, Botelho F, de Souza Gomez D, Alonso N, Pompermaier L. Who Gets Burned in Brazil? J Burn Care Res 2024; 45:926-931. [PMID: 37139956 DOI: 10.1093/jbcr/irad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Indexed: 05/05/2023]
Abstract
Burns are preventable injuries that still represent a relevant public health issue. The identification of risk factors might contribute to the development of specific preventive strategies. Data of patients admitted at the Hospital due to acute burn injuries from May 2017 to December 2019, was extracted manually from medical records. The population was analyzed descriptively, and differences between groups were tested using the appropriate statistical test. The study population consisted of 370 patients with burns admitted to the Hospital burn unit during the study period. The majority of the patients were males (257/370, 70%), median age was 33 (IQR:18-43), median TBSA% was 13 (IQR 6.35-21.5 and range 0-87.5%), and 54% of patients had full-thickness burns (n = 179). Children younger than 13 years old represented 17% of the study population (n = 63), 60% of them were boys (n = 38), and scalds was the predominant mechanism of burn injury (n = 45). No children died, however 10% of adults did (n = 31). Self-inflicted burns were observed in 16 adults (5%), of whom 6 (38%) died during admission, however self-inflicted burns were not observed in children. Psychiatric disorders and substance misuse were frequent in this subgroup. White adults male from urban areas who had not completed primary school degree were the major risk group for burns. Smoking and alcohol misuse were the most frequent comorbidities. Accidental domestic flame burns were the predominant injuries in the adult population and scalds in the pediatric.
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Affiliation(s)
- Mariana Graner
- School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Marcela Gutierre
- School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Lucas S Salgado
- School of Medicine, União Educacional do Vale do Aço, Ipatinga, MG, Brazil
| | | | - João Baptista
- School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Alexandra M Buda
- Harvard Medical School-Program in Global Surgery and Social Change Boston, Massachusetts, USA
| | - Alexis N Bowder
- Harvard Medical School-Program in Global Surgery and Social Change Boston, Massachusetts, USA
| | - D Scott Corlew
- Harvard Medical School-Program in Global Surgery and Social Change Boston, Massachusetts, USA
| | | | | | - Nivaldo Alonso
- Department of Plastic Surgery, University of São Paulo, São Paulo, Brazil
| | - Laura Pompermaier
- Department of Hand Surgery, Plastic Surgery and Burns, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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4
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Cho N, Koti AS. Identifying inflicted injuries in infants and young children. Semin Pediatr Neurol 2024; 50:101138. [PMID: 38964814 DOI: 10.1016/j.spen.2024.101138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/04/2024] [Accepted: 05/07/2024] [Indexed: 07/06/2024]
Abstract
Child physical abuse is a common cause of pediatric morbidity and mortality. Up to half of all children presenting with abusive injuries have a history of a prior suspicious injury, suggesting a pattern of repeated physical abuse. Medical providers are responsible for identifying children with suspicious injuries, completing mandated reporting to child protective services for investigation, and screening for occult injuries and underlying medical conditions that can predispose to injuries. Early identification of inflicted injuries appropriate evaluations may serve as an opportunity for life-saving intervention and prevent further escalation of abuse. However, identification of abuse can be challenging. This article will review both physical exam findings and injuries that suggest abuse as well as the evaluation and management of physical abuse.
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Affiliation(s)
- Nara Cho
- Division of Child and Family Advocacy, Department of Pediatrics, Nationwide Children's Hospital, 655 E Livingston Ave, Columbus, OH 43205, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States.
| | - Ajay S Koti
- Safe Child and Adolescent Network, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, United States; University of Washington School of Medicine, Seattle, WA, United States
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Liu T, Qu Y, Chai J, Liu X, Hu F, Zhang D, Duan H, Chi Y. Epidemiology and first aid measures in pediatric burn patients in northern China during 2016-2020: A single-center retrospective study. Health Sci Rep 2024; 7:e2218. [PMID: 39072351 PMCID: PMC11273291 DOI: 10.1002/hsr2.2218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 06/02/2024] [Accepted: 06/13/2024] [Indexed: 07/30/2024] Open
Abstract
Background and Aims Burn and scald injuries are the fourth most common type of trauma. Pediatric burns account for a high proportion of the total number of burn patients and impose a high burden on public health. Understanding the epidemiology of pediatric burns can help improve science education and reduce the incidence of burn injuries. Methods This study is a single-center retrospective study. One thousand five hundred and twenty-seven pediatric burn patients admitted to our burn center from January 2016 to December 2020 were included. Demographic and epidemiological data of included patients were extracted and analyzed. The correlations of categorical data were tested by the Chi-square tests, and differences of continuous data were tested by the Kruskal-Wallis tests. A p-value of less than 0.05 was considered to be statistically significant. Results The results showed that children under 3 years of age were most susceptible to burn and scald injuries. Burn injuries were most likely to occur in the season of winter and at the place of home. 56.6% of included patients did receive first aid measures, while 1.8% received gold-standard first aid. Clinical variables related to the severity of injuries were statistically different between patients with and without cooling measures in first aid. Linear regression models showed that emergency treatment of burns in children and adolescents was associated with outcome indicators, including number of operations, total operation duration per total burn surface area (TBSA), cost per TBSA, and length of stay per TBSA. Conclusions This study summarized the epidemiology and outcomes of pediatric burn patients admitted to a burn center in northern China. Adopting cooling measures in first aid can reduce the severity of injuries and reduce the burden on the medical system. Education on burn prevention and first aid measures to caregivers of children, especially preschool children, should be strengthened.
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Affiliation(s)
- Tian Liu
- Senior Department of Burns & Plastic SurgeryThe Fourth Medical Center of PLA General HospitalBeijingChina
- Department of Burn and Plastic SurgeryGeneral Hospital of Southern Theater Command, PLAGuangzhouChina
| | - Yirui Qu
- Chinese PLA General Hospital & Chinese PLA Medical SchoolBeijingChina
| | - Jiake Chai
- Senior Department of Burns & Plastic SurgeryThe Fourth Medical Center of PLA General HospitalBeijingChina
| | - Xiangyu Liu
- Chinese PLA General Hospital & Chinese PLA Medical SchoolBeijingChina
| | - Fangchao Hu
- Chinese PLA General Hospital & Chinese PLA Medical SchoolBeijingChina
| | - Dongliang Zhang
- Department of Burns and Cutaneous Surgery, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Hongjie Duan
- Senior Department of Burns & Plastic SurgeryThe Fourth Medical Center of PLA General HospitalBeijingChina
| | - Yunfei Chi
- Senior Department of Burns & Plastic SurgeryThe Fourth Medical Center of PLA General HospitalBeijingChina
- Chinese PLA General Hospital & Chinese PLA Medical SchoolBeijingChina
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Schermerhorn SMV, Muensterer OJ, Ignacio RC. Identification and Evaluation of Non-Accidental Trauma in the Pediatric Population: A Clinical Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:413. [PMID: 38671630 PMCID: PMC11049109 DOI: 10.3390/children11040413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
Non-accidental trauma (NAT) is a major cause of morbidity and mortality for children around the world and most significantly impacts children under one year of age. Prompt and comprehensive treatment of these children relies on a high index of suspicion from any medical provider that treats pediatric patients. This review discusses those most at risk for experiencing NAT, and common initial presentations, to assist providers in the identification of potential victims. In addition, this review provides guidance on the recommended workup for these patients so that the full extent of associated injuries may be identified and the appropriate healthcare team may be assembled.
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Affiliation(s)
| | - Oliver J. Muensterer
- LMU Medical Center, Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University, Lindwurmstrasse 4, 80337 Munich, Germany;
| | - Romeo C. Ignacio
- Department of Surgery, UCSD School of Medicine, 9500 Gilman Dr, La Jolla, CA 92093, USA
- Division of Pediatric Surgery, Rady Children’s Hospital San Diego, 3020 Children’s Way, San Diego, CA 92123, USA
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Hamza Hermis A, Tehrany PM, Hosseini SJ, Firooz M, Hosseini SR, Jamshidbeigi A, Zaboli Mahdiabadi M, Ghorbani Vajargah P, Mollaei A, Karkhah S, Takasi P, Alizadeh Otaghvar H, Farzan R. Prevalence of non-accidental burns and related factors in children: A systematic review and meta-analysis. Int Wound J 2023; 20:3855-3870. [PMID: 37224877 PMCID: PMC10588353 DOI: 10.1111/iwj.14236] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023] Open
Abstract
Non-accidental burns (NABs) in children had some adverse effects, such as severe burns, requiring skin grafting, and mortality. Previous studies reported NABs in the form of neglect, suspected abuse, and child abuse. Also, different statistics were estimated for the prevalence of NABs in children. Therefore, the current study aimed to comprehensively review and summarise the literature on the prevalence of NABs in children. Also, factors related to NABs as a secondary aim were considered in this review. Keywords combined using Boolean operators and searches were performed in international electronic databases, such as Scopus, PubMed, and Web of Science. Only studies in English were considered from the earliest to 1 March 2023. The analysis was performed using STATA software version 14. Finally, 29 articles were retrieved for the quantitative analysis. Results found that the prevalence of child abuse, suspected abuse, neglect, 'child abuse or suspect abused', and 'abuse, suspect abused, or neglect' was 6% (ES: 0.06, 95% confidence interval [CI]: 0.05-0.07), 12% (ES: 0.12, 95% CI: 0.09-0.15), 21% (ES: 0.21, 95% CI: 0.07-0.35), 8% (ES: 0.08, 95% CI: 0.07-0.09), and 15% (ES: 0.15, 95% CI: 0.13-0.16) among burns victims, respectively. Also, factors related to NABs are categorised into age and gender, agent and area of burns, and family features. Considering the results of the current study, planning for rapid diagnosis and designing a process to manage NABs in children is necessary.
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Affiliation(s)
| | - Pooya M. Tehrany
- Department of Orthopaedic Surgery, Faculty of MedicineNational University of MalaysiaBaniMalaysia
| | - Seyed Javad Hosseini
- Department of Pediatric Nursing, School of Nursing and MidwiferyMashhad University of Medical SciencesMashhadIran
- Department of NursingEsfarayen Faculty of Medical SciencesEsfarayenIran
| | - Mahbobeh Firooz
- Department of NursingEsfarayen Faculty of Medical SciencesEsfarayenIran
- School of Nursing and MidwiferyGolestan University of Medical SciencesGorganIran
| | - Seyed Reza Hosseini
- Student Research Committee, Faculty of Nursing and MidwiferyMashhad University of Medical SciencesMashhadIran
| | - Amirreza Jamshidbeigi
- Student Research Committee, Faculty of Nursing and MidwiferyMashhad University of Medical SciencesMashhadIran
| | | | - Pooyan Ghorbani Vajargah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Amirabbas Mollaei
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Samad Karkhah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Poorya Takasi
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Hamidreza Alizadeh Otaghvar
- Department of Plastic Surgery, Trauma and Injury Research CenterIran University of Medical SciencesTehranIran
| | - Ramyar Farzan
- Department of Plastic & Reconstructive Surgery, School of MedicineGuilan University of Medical SciencesRashtIran
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Gasteratos K, McCarthy M, Chatziathanasiou D, Vradeli G, Vlachopoulos N, Voitsidis P, Goverman J. A Systematic Review of Pediatric Nonaccidental Burns: Protecting the Children Through Knowledge, Vigilance, and Prevention. Ann Plast Surg 2023; 90:551-558. [PMID: 37157138 DOI: 10.1097/sap.0000000000003559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Inflicted burns on children are a particularly difficult medical and psychosocial issue. Pediatric nonaccidental burns (PNABs) are unfortunately relatively common. In our study, we aim to present the key findings on PNABs with the intention of raising awareness, improving early, and recognizing accurately by identifying red flags, developing triage tools, and establishing prevention strategies for this sensitive issue. METHODS A computerized literature search was conducted on PubMed, Google Scholar, and Cochrane for articles published until November 2020. The online screening process was performed by 3 independent reviewers with the Covidence tool against set inclusion/exclusion criteria. The protocol was reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO). RESULTS A total of 12 studies were included for analysis. Scald burns via forced immersion accounted for the majority of reported PNABs affecting both feet and hands. Complications included wound infection, sepsis, requiring systemic antibiotics, or intensive care. Abused children's parents had a history of mental illness, unemployment, substance abuse, incarceration, and/or low annual income. CONCLUSIONS Scalds via forced immersion remain the most common mechanism of PNABs. All health care professionals must remain vigilant, be able to recognize subtle signs of abuse, triage patients appropriately, report to police and/or social services, and ensure no further harm is made to the child or children. Repeated abuse with burns can lead to death. Prevention and education are the cornerstones for addressing this social phenomenon.
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Affiliation(s)
| | | | | | - Georgia Vradeli
- Department of Dermatology, Städtisches Klinikum Dessau, Germany
| | | | - Pantelis Voitsidis
- 1st Psychiatric Clinic, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jeremy Goverman
- Sumner M. Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Boston, MA
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Yakupu A, Zhang J, Dong W, Song F, Dong J, Lu S. The epidemiological characteristic and trends of burns globally. BMC Public Health 2022; 22:1596. [PMID: 35996116 PMCID: PMC9396832 DOI: 10.1186/s12889-022-13887-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Burns is a type of injury, caused by unintentional exposure to substances of high temperature, including hot liquid, solid, and objects radiating heat energy, placing a high burden not only on patients’ families but also on national healthcare systems globally. It is difficult for policymakers and clinicians to formulate targeted management strategies for burns because data on current epidemiological patterns worldwide are lacking. Methods Data on burns were obtained from the Global Burden of Disease (GBD) 2019 Study. The incidence, disability-adjusted life years (DALYs), and deaths of burns in 204 countries and regions from 1990 to 2019 were calculated and stratified by sex, age, geographical location, and sociodemographic index (SDI). The estimated annual percentage change (EAPC) of incidence, DALYs, and deaths was calculated to evaluate the temporal trends. All analyses were performed using R software, version 4.1.1, with 2-sided P-values < .05 indicating a statistically significant difference. Results A total of 8,378,122 new cases (95% UI, 6,531,887–10,363,109cases) of burns were identified globally in 2019, which is almost evenly split between men and women, and most of the new cases were concentrated in the 10–19-year age group. Besides, burns account for 111,292 deaths (95% UI, 132,392–88,188) globally in 2019, most of which were concentrated in those aged 1–4 years. The burden of burns measured in DALYs was 7,460,448.65 (95% UI, 5,794,505.89–9,478,717.81) in 2019, of which 67% and 33% could be attributed to YLLs and YLDs, respectively. The EAPC of incidence, DALYs, and deaths were negative, the age-standardized rate (ASR) of incidence, DALYs, and deaths were considered to be decreasing in most of the regions, and the EAPCs were negatively correlated with SDI levels, universal health coverage (UHC), and gross domestic product (GDP). Conclusion Globally, the age-standardized rates of burn incidence, DALYs, and mortality, as well as the number of burn DALYs and death cases will continuously decrease, but the number of new burn cases has an increasing tendency globally. In addition, the EAPCs of burns in incidence, DALYs, and deaths indicated that the burden of burns was considered to be decreasing in most of the regions. And from the relationship of EAPCs with SDI, UHC index, and GDP, indicate that prevention burns not only depend on health spending per capita but also depend on the education level per capita and healthcare system performance, but it does not mean higher health spending corresponds to higher UHC index, which needs high efficiency of translating health spending into individuals health gains. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13887-2.
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Affiliation(s)
- Aobuliaximu Yakupu
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhang
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Dong
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Song
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaoyun Dong
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Burn Institute, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Shuliang Lu
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Burn Institute, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, China.
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10
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Liu H, Li D, Sun T, Deng H, Li L, Cai J, Shen C. Platelet distribution width associated with short-term prognosis and cost in paediatrics with partial-thickness thermal burns: A retrospective comparative study. Int Wound J 2022; 19:1853-1859. [PMID: 35706362 DOI: 10.1111/iwj.13791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/24/2022] [Accepted: 03/05/2022] [Indexed: 12/01/2022] Open
Abstract
Platelets exert important roles in burn wound healing and involving in inflammatory regulation and tissue repair. Platelet distribution width (PDW) is an indicator representing platelet morphology and activation. In this study, we try to evaluate the value of PDW in predicting short-term prognosis and cost of paediatrics with partial-thickness thermal burns. This retrospective study enrolled 73 children with partial-thickness thermal burns. The Ability of PDW to predict wound healing was evaluated by receiver operating characteristic (ROC) curve. All 73 patients were assigned into high and low PDW group according to optimal cut-off value from ROC curve. Associations between PDW and 2-weeks healing rate, time to wound healing, in-hospital cost and length of stay were evaluated. Furthermore, Univariate and multivariate logistic regression analysis were used to furtherly evaluate the significance of PDW in wound healing. We found that all baseline characteristics between groups were comparable (all P > .05). High PDW group had a significant higher 2-weeks wound healing rate than those with a low PDW (66.7% versus 32.6%, P < .01). Moreover, the mean time to wound healing of high PDW was obviously shorter than that of low PDW group (15.4 ± 10.1 vs 20.7 ± 10.9, P = .04). Univariate (OR: 0.24, 95%CI: 0.09-0.65, P < .01) and multivariate (OR: 0.15, 95CI%:0.05-0.52, P < .01) analysis confirmed PDW as an independent marker for wound healing. Patients in high PDW group had a significant lower medical burden than low PDW group, including in-hospital cost (13.7 ± 10.6 vs 21.9 ± 16.7, ×103RMB, P = .02) and length of stay (12.2 ± 8.8 vs 19.0 ± 10.8 days, P < .01). In conclusion, PDW can sever as a potential indictor to predict the short-term prognosis of paediatrics with partial thickness thermal burns.
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Affiliation(s)
- Hailiang Liu
- From Department of Burns and Plastic Surgery, The Forth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Dongjie Li
- From Department of Burns and Plastic Surgery, The Forth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Tianjun Sun
- From Department of Burns and Plastic Surgery, The Forth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Huping Deng
- From Department of Burns and Plastic Surgery, The Forth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ligen Li
- From Department of Burns and Plastic Surgery, The Forth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jianhua Cai
- From Department of Burns and Plastic Surgery, The Forth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chuanan Shen
- From Department of Burns and Plastic Surgery, The Forth Medical Center, Chinese PLA General Hospital, Beijing, China
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Loos MLHJ, Meij-de Vries A, Nagtegaal M, Bakx R. Child abuse and neglect in paediatric burns: The majority is caused by neglect and thus preventable. Burns 2022; 48:688-697. [PMID: 34103201 DOI: 10.1016/j.burns.2021.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/05/2021] [Accepted: 05/14/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION It is complex to distinguish negligent burns from inflicted and non-intentional burns, especially since no deliberate action caused the burn. Its recognition is important to create a safe life without (future) burns for our loved-ones who cannot take care of themselves (yet). Our aim was to investigate the incidence and associated characteristics of negligent burns are among children treated at a burn center. METHODS We retrospectively reviewed medical files of all children attending a Dutch burn center with an acute burn between January 2013-December 2015. The conclusion of the Child Abuse and Neglect team (CAN) was used to define inflicted, negligent or non-intentional burns. The remaining cases were reviewed by an expert panel using a standardized protocol. Demographic and social data as well as clinical information about the burn were collected. RESULTS In total 330 children were included. Negligent burns accounted for 56%, non-intentional for 42% and inflicted for 2% of the burns. Negligent burns were associated with: hot beverages (OR 4.40, 95%CI 2.75-7.05), a younger age (p < 0.001), occurrence at home (OR 4.87 95%CI 2.80-8.45) and were located at the anterior trunk (OR 2.75, 95%CI 1.73-4.35) and neck (OR 1.98, 95%CI 1.12-3.50). CONCLUSION This study shows that neglect is a major factor in the occurrence of burns in young children, therefore we conclude that the majority of paediatric burns are preventable. Educational programs creating awareness and focussing on prevention of these burns should be aimed at households, since the majority of negligent as cause of preventable burns occur at home.
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Affiliation(s)
- Marie-Louise H J Loos
- Emma Children's Hospital, Paediatric Surgical Centre Amsterdam, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Paediatric Surgery, Amsterdam, The Netherlands.
| | - Annebeth Meij-de Vries
- Emma Children's Hospital, Paediatric Surgical Centre Amsterdam, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Paediatric Surgery, Amsterdam, The Netherlands; Red Cross Hospital, Burn Center Beverwijk, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - Michelle Nagtegaal
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Social Paediatrics, Amsterdam, The Netherlands; Department of Forensic Medicine, Section on Forensic Paediatrics, Netherlands Forensic Institute, The Hague, The Netherlands.
| | - Roel Bakx
- Emma Children's Hospital, Paediatric Surgical Centre Amsterdam, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Paediatric Surgery, Amsterdam, The Netherlands.
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12
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Pediatric major burns: a monocentric retrospective review of etiology and outcomes (2008–2020). EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01957-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Background
Burns are one of the most common causes of mortality and morbidity among children. This study aims to assess the epidemiology of pediatric major burns in a third level hospital in Spain to evaluate demographics, etiology, and outcomes.
Methods
A retrospective study was held by the Plastic, Reconstructive and Burn Surgery department of the hospital. We included 147 patients under 18 admitted to hospital between January 2008 and December 2020 who meet the inclusion criteria: partial thickness burns > 10% total body surface area (TBSA) in patients < 18 years old. Clinical data extracted included age, gender, date of admission, %TBSA, burn types, severity and sites of burn, length of stay, length of ventilator support, intensive care admission, blood transfusion, surgical interventions, and complications.
Results
Three groups of age were analyzed. The average %TBSA was 18.7 (SE 0.9). Scalds were the main mechanism of injury (70.1%) and upper extremity was the most frequent location affected (68%). The 28.6% of patients suffered some complication, but the mortality rate was low (0.7%). In our series, the group aged 13–18 showed significantly higher %TBSA, more number of surgeries and blood transfusions.
Conclusions
Scald burns are the most frequent mechanism of injury in pediatric burns. However, teenagers suffer more severe burns and complications, usually caused by flame. Despite the low mortality rates, more measures of prevention should be taken to increase children security.
Level of evidence: Level IV, Risk/Prognostic.
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McAlister P, Hagan G, Lowry C, Mullen S. Fifteen-minute consultation: Management of paediatric minor burns. Arch Dis Child Educ Pract Ed 2022:archdischild-2021-323229. [PMID: 35063949 DOI: 10.1136/archdischild-2021-323229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/15/2021] [Indexed: 11/04/2022]
Abstract
Burn injuries are a common presentation to the paediatric emergency department (PED) and are painful, distressing and may have long-term sequelae. In adhering to the first aid principles of burns management, we aim to alleviate pain, prevent bacterial contamination and minimise the extent of injury. First aid involves cooling the burn and covering with an appropriate material while simultaneously providing analgesia. Assessing the severity (depth and total body surface area) of the burn are important for prognostication with implications for management. It is imperative to consider non-accidental injury in burns, which be present in 10% of cases .
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Affiliation(s)
- Peter McAlister
- Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Gary Hagan
- Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Christopher Lowry
- Paediatric Emergency Department, Royal Belfast Children's Hospital, Belfast, UK
| | - Stephen Mullen
- Paediatric Emergency Department, Royal Belfast Hospital for Sick Children, Belfast, UK .,Faculty of Medicine, Health and Life Sciences, Queen's University, Belfast, UK
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Javaid AA, Johnson E, Hollén L, Kemp AM. Influence of agents and mechanisms of injury on anatomical burn locations in children <5 years old with a scald. Arch Dis Child 2021; 106:1111-1117. [PMID: 33727239 DOI: 10.1136/archdischild-2020-320710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/04/2022]
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.
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Affiliation(s)
- Assim Ali Javaid
- Department of Population Health, Cardiff University, Cardiff, UK
| | - Emma Johnson
- Paediatric Department, New Cross Hospital, Wolverhampton, UK
| | - Linda Hollén
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alison Mary Kemp
- Division of Population Medicine, Department of Child Health, Cardiff, UK
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Autsch A, Sauer S, Mall G, Wittschieber D. Heiße Spuren. Rechtsmedizin (Berl) 2021. [DOI: 10.1007/s00194-021-00501-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDie Differenzialdiagnostik von Hautläsionen bei Lebenden gehört zum wesentlichen Aufgabenspektrum der „klinischen Rechtsmedizin“. Im vorliegenden Fall eines 10 Monate alten Jungen mit nichtjuckenden, jedoch geformt wirkenden Hautläsionen bat die behandelnde Kinderarztpraxis um rechtsmedizinische Mitbeurteilung wegen des Verdachts einer Misshandlung von Schutzbefohlenen mittels glühender Zigarettenspitzen. Auf Fotografien vom Tag der Erstvorstellung in der Kinderarztpraxis sowie von der Wiedervorstellung einen Tag später waren im linken oberen Rückenbereich mehrere rundliche Hautläsionen zu erkennen. Bei der nachfolgenden rechtsmedizinischen Untersuchung erschienen diese Läsionen nun mit goldgelb-braunen Krustenbildungen. Die Kenntnis der Läsionsentwicklung sowie der charakteristische Endbefund ermöglichten die sichere Diagnose einer Impetigo contagiosa. Der Fall verdeutlicht die Notwendigkeit der engen Kooperation zwischen Klinik und Rechtsmedizin bei Sachlagen und Befunden mit initial möglich erscheinender strafrechtlicher Relevanz.
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Tiyyagura G, Emerson B, Gaither JR, Bechtel K, Leventhal JM, Becker H, Della Guistina K, Balga T, Mackenzie B, Shum M, Shapiro ED, Auerbach MA, McVaney C, Morrell P, Asnes AG. Child Protection Team Consultation for Injuries Potentially Due to Child Abuse in Community Emergency Departments. Acad Emerg Med 2021; 28:70-81. [PMID: 32931628 DOI: 10.1111/acem.14132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/20/2020] [Accepted: 09/06/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Emergency care for children is provided predominantly in community emergency departments (CEDs), where abusive injuries frequently go unrecognized. Increasing access to regional child abuse experts may improve detection of abuse in CEDs. In three CEDs, we intervened to increase involvement of a regional hospital child protection team (CPT) for injuries associated with abuse in children < 12 months old. We aimed to increase CPT consultations about these infants from the 3% baseline to an average of 50% over 12 months. METHODS We interviewed CED providers to identify barriers and facilitators to recognizing and reporting abuse. Providers described difficulties differentiating abusive from nonabusive injuries and felt that a second opinion would help. Using a plan-do-study-act approach, beginning in April 2018, we tested, refined, and implemented interventions to increase the frequency of CPT consultation, including leadership and champion engagement, provider training, clinical pathway implementation, and an audit and feedback process. Data were collected for 15 months before and 17 months after initiation of interventions. We used a statistical process control chart to track CPT consultations about children < 1 year old with high-risk injuries, use of skeletal surveys (SSs), and reports to child protective services (CPS). RESULTS Evidence of special cause was identified beginning in June 2018, with a shift of 8 points to one side of the center line. For the subsequent 8-month period, the CPT was consulted for a mean of 47.5% of children with high-risk injuries; this was sustained for an additional 7 months. The average percentage of infants with high-risk injuries who received a SS increased from 6.7% to 18.9% and who were reported to CPS increased from 10.7% to 32.6%. CONCLUSION Targeted interventions in CEDs increased the frequency of CPT consultation, SS use, and reports to CPS for infants with high-risk injuries. Such interventions may improve recognition of physical abuse.
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Affiliation(s)
- Gunjan Tiyyagura
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Beth Emerson
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Julie R. Gaither
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Kirsten Bechtel
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - John M. Leventhal
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Heather Becker
- the Department of Emergency Medicine Bridgeport Hospital Bridgeport CTUSA
| | | | - Thomas Balga
- and the Department of Emergency Medicine Yale New Haven Hospital New Haven CT USA
| | - Bonnie Mackenzie
- and the Department of Emergency Medicine Lawrence and Memorial Hospital Norwich CTUSA
| | - May Shum
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Eugene D. Shapiro
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Marc A. Auerbach
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Caitlin McVaney
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Patricia Morrell
- and the Department of Surgery Yale New Haven Hospital New Haven CT USA
| | - Andrea G. Asnes
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
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Adelgais K, Pusic M, Abdoo D, Caffrey S, Snyder K, Alletag M, Balakas A, Givens T, Kane I, Mandt M, Roswell K, Saunders M, Boutis K. Child Abuse Recognition Training for Prehospital Providers Using Deliberate Practice. PREHOSP EMERG CARE 2020; 25:822-831. [PMID: 33054522 DOI: 10.1080/10903127.2020.1831671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In most states, prehospital professionals (PHPs) are mandated reporters of suspected abuse but cite a lack of training as a challenge to recognizing and reporting physical abuse. We developed a learning platform for the visual diagnosis of pediatric abusive versus non-abusive burn and bruise injuries and examined the amount and rate of skill acquisition. METHODS This was a prospective cross-sectional study of PHPs participating in an online educational intervention containing 114 case vignettes. PHPs indicated whether they believed a case was concerning for abuse and would report a case to child protection services. Participants received feedback after submitting a response, permitting deliberate practice of the cases. We describe learning curves, overall accuracy, sensitivity (diagnosis of abusive injuries) and specificity (diagnosis of non-abusive injuries) to determine the amount of learning. We performed multivariable regression analysis to identify specific demographic and case variables associated with a correct case interpretation. After completing the educational intervention, PHPs completed a self-efficacy survey on perceived gains in their ability to recognize cutaneous signs of abuse and report to social services. RESULTS We enrolled 253 PHPs who completed all the cases; 158 (63.6%) emergency medical technicians (EMT), 95 (36.4%) advanced EMT and paramedics. Learning curves demonstrated that, with one exception, there was an increase in learning for participants throughout the educational intervention. Mean diagnostic accuracy increased by 4.9% (95% CI 3.2, 6.7), and the mean final diagnostic accuracy, sensitivity, and specificity were 82.1%, 75.4%, and 85.2%, respectively. There was an increased odds of getting a case correct for bruise versus burn cases (OR = 1.4; 95% CI 1.3, 1.5); if the PHP was an Advanced EMT/Paramedic (OR = 1.3; 95% CI 1.1, 1.4) ; and, if the learner indicated prior training in child abuse (OR = 1.2; 95% CI 1.0, 1.3). Learners indicated increased comfort in knowing which cases should be reported and interpreting exams in children with cutaneous injuries with a median Likert score of 5 out of 6 (IQR 5, 6). CONCLUSION An online module utilizing deliberate practice led to measurable skill improvement among PHPs for differentiating abusive from non-abusive burn and bruise injuries.
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