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Can introduction of a compulsory burns protocol in paediatric emergency departments increase detection of NAI in preschool children?
  1. Farooq Pasha

Abstract

Objective To assess whether use of a compulsory burns protocol in all preschool children attending a dedicated peadiatric emergency department with burns and scalds increases detection of non-accidental injury (NAI), improves case notes documentation and management of cases.

Methods The case notes of all preschool children who attended the emergency department with burns and scalds over a 6 month period where reviewed against a basic predetermined standard in agreement with experienced child protection paediatricians. A similar prospective study was performed after introduction of a burns protocol for a similar period of time in the same paediatric emergency department.

Results Both groups were similar in their demographic characteristics. Only 12% case notes were deemed satisfactory when compared against the basic standard. This increased to 92% after introduction of the burns proforma. The rate of referral for further investigation as NAI in burns increased from 0.9% to 6.8% which was statistically significant. Similarly a substantial improvement was seen in the quality of note keeping, consistency of history, checks with EDT/previous attendences, photograhic evidence, pain score documentation and appropriate use of analgesia.

Conclusion Documentation of burns in preschool children with possibility of NAI in a busy paediatric emergency department can be improved by using a compulsory burns proforma along with a significant improvement in referrals to child protection team for further assessment.

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