Source: Javaid AA, Johnson E, Hollén L, et al. Influence of agents and mechanisms of injury on anatomical burn locations in children <5 years old with a scald. Arch Dis Child. 2021 Nov;106(11):1111-1117. doi: 10.1136/archdischild-2020-320710Investigators from multiple institutions in the United Kingdom conducted a prospective study to characterize scalds in young children by mechanism, agent causing the burn, and anatomic site, and to compare these characteristics in children with scalds classified as accidental and in those whose scalds led to a referral for a child protection (CP) assessment. For the study, data on scalds in children <5 years old, presenting to 1 of 20 hospital sites between August 2015 and September 2018, were collected using a standardized form, the Burns and Scalds Assessment Template. On the form, clinicians reported mechanism of injury (including “pull down,” “spill,” “immersion,” independent of child, and unwitnessed), agent causing the burn (such as hot liquid in a cup or mug, hot water in kitchen utensils, hot water in bath/shower, and hot food), and anatomic site involved. Demographic data and information on whether a CP referral was made also were collected. Differences in the mechanism, agent, and anatomic site of scalds that were classified as accidental and those prompting a CP referral were compared with Chi-square tests or Fisher’s exact test.Data were analyzed on 1,041 children <5 years old with scalds. Overall, 55.7% of participants were male, and 49.7% were between 1 and 2 years old. Scalds were classified as accidental in 938 children (90%) and prompted a CP referral in 92 (10%). Overall, 644 scalds (61.9%) involved 1 anatomic site, and 359 (34.5%) involved adjacent areas. Only 38 scalds involved multiple or nonconfluent areas. The most common agent for accidental scalds was hot liquid in a cup or mug (664 cases, 70.7% of accidental scalds), followed by hot water from a kitchen utensil (211, 22.5%); only 15 (1.6%) accidental scalds were from hot water in baths/showers. The most common mechanism of injury for scalds was pull down (620 cases, 59.6%). The most commonly injured anatomic sites were trunk (347 cases) and head (241 cases). Factors associated with increased chance of a CP referral were scalds from hot water from baths/showers (OR, 8.2; 95% CI, 3.7, 18.3), unwitnessed scalds (OR, 3.6; 95% CI 1.3, 5.4), and symmetrical scald injuries (OR, 4.9; 95% CI, 2.7, 9.1). There was no statistically significant association between anatomic location and referral to CP.The authors conclude that the results of the study provide important information for clinicians evaluating young children with scald injuries.Dr Alissa has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Burns are a common cause of preventable morbidity and mortality in children.1 To be specific, hot beverage scalds are a leading cause of burns in young children.2 It is concerning to know that children younger 3 years old are less likely to receive appropriate first aid at the scene.2,3 Hot beverage scald prevention via parental education is the goal to reduce the incidence of scalds in children.3Although the referral to child protection is more likely to be reserved for unwitnessed and symmetric scalds as discussed in the current study; it is worth remembering that inflicted burns are serious in nature.4 Training of the health care team taking care of children with burns is crucial to identify abuse or neglect for early social intervention.4The strength of the current study comes from its aim to identify the mechanism and agent of injury simply by the anatomical location of the scald, since it can be a much-needed tool for the first responders to provide first aid at the scene5 and for the ED providers to manage these children in a timely manner.6 The main limitation of this study is the lack of information regarding the reason behind the small number of cases referred for CP assessment.Scalds in children are most likely to be accidental. Prevention of scalds by parental education remains the goal.Although the results of this study may appear to be intuitive, they bear repetition. Pull-down scalds mostly involve the upper body; scalds from spills tend to injure the lower body. Beware the hot liquid residing in or on the oven.
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