Prevention of paediatric hot beverage scalds

Abstract

Hot beverage scalds are a painful and, unfortunately, common burn injury in children accounting for 1 in 5 of all childhood burns treated. Despite the high incidence, physical suffering, potential psychological issues, and significant financial costs to the healthcare system, there is a paucity of research and initiatives aimed at preventing hot beverage scalds (HBS). The aim of this research is to provide a better understanding of HBS injuries and develop an intervention aimed at preventing them.The research was undertaken in four stages—each informing the subsequent stages—and culminating in a HBS prevention intervention strategy. In Stage 1, the magnitude of the injury was highlighted through a retrospective trend analysis which compared data on children presenting to a major paediatric burn centre in Brisbane, Australia, with historical data from the same burn centre 10 years earlier. Stage 2 investigated the potential risk and protective factors for HBS through a cross-sectional survey of parents/caregivers of young children with HBS delivered, via iPad prior to the child’s burn dressing change. This survey provided detailed information about the circumstances surrounding the scald injury—before, during and immediately after.Evidence shows that applying optimal first aid treatment to a burn/scald (20-minutes of cool running water within 3 hours of the burn occurring) significantly improves wound outcomes; however, there is poor knowledge and use of correct burn first aid in the general population. Due to the high level of reporting of Internet use as a primary source of burn first aid information, identified in Stage 2, Stage 3 of this thesis comprises an analysis of burn first aid information available on the Internet. Combining findings from Stages 1-3, an innovative burn prevention intervention was developed: Cool Runnings. This two-group, parallel, single-blinded, randomised controlled trial (RCT) used a gamified, app-based intervention to improve knowledge among Queensland-based mothers of young children about childhood burn risks and burn first aid.This thesis presents the findings from these four studies. Stage 1 confirmed that the high proportion of HBS has not changed since 1999-2002; HBS still account for 20% of all childhood burns treated. The majority of HBS (75%) occur in children under 2 years old, often in the child’s home, and are witnessed by an adult. Stage 2 showed the supervising adult was usually in close proximity to the child when the injury occurred (often within arm’s reach) but were often distracted by food/drink preparation or attending to other family members. Only 28% of children received optimal burn first aid at the scene. Many of the parents and caregivers initially applied cool water to the scald but not for the recommended 20 minutes. The primary outcome measure of the RCT (Stage 4) was a change in knowledge about burn risk and burn first aid. The secondary outcome measure was the use of gamification. Participants were recruited for the RCT via social media, which resulted in the enrolment of 498 participants in just 30 days. Those recruited were representative of the target population. The Cool Runnings intervention resulted in a significant improvement in knowledge between the baseline and six-month follow-up, and this improvement correlated with gamification and app-activity.This thesis provides a comprehensive overview of hot beverage scalds, a childhood injury that has received little attention despite its high occurrence. The information gathered from these studies provides a better understanding of the circumstances surrounding HBS, and highlights the inadequate knowledge of many parents and caregivers about childhood burn risks and burn first aid. This knowledge is crucial if we are to see a reduction in HBS injuries.The success of the Cool Runnings RCT has led to a national burns prevention and first aid education campaign being rolled out across Australia. Called ‘Cool Runnings’, this free app-based campaign uses content and gamification techniques from the RCT, along with broader adult and child burn risk content, in an attempt to reduce burn rates and improve correct burn first aid knowledge among the general public.The research findings from this thesis can be used to inform other HBS prevention initiatives, and the effectiveness of the gamified, app-based intervention highlights the potential of innovative new technologies for other childhood injury interventions and public health campaigns at a lower cost than traditional methods.