Background 10% of all burns arise from physical abuse or neglect. It can be difficult to identify cases where non-accidental injury should be suspected and Emergency Department (ED) clinicians have a short time to assess a child. Children less than 5 years of age are most at risk of burn injuries, with scalds and contact burns being the most common burn type amongst this group. This study analyses cases of scalds and contact burns that present to ED to determine whether there are any significant differences between factors involved in accidental burns and those referred to social services.

Method and results A prospective multicentred study was conducted from August 2015 to September 2018. Data were collected from 20 hospital sites across England and Wales for all children who presented with a burn. Children who were less than 5 years old and had suffered a scald or contact burn were included in this study. Comparison of the proportions of cases affected by different agents, mechanisms and locations of injury were made between accidental cases (non-CP) and those cases for which a child protection referral was made (CP) to determine whether there were any significant differences. Chi-squared testing was used for this comparison and statistical significance was set at p<0.05.

Conclusions After exclusion criteria were applied, 2056 cases were identified; 1045 non-CP scalds, 103 CP scalds, 816 non-CP contact burns and 92 CP contact burns. Scalds; Hot Water scalds and Unwitnessed scalds were statistically significantly more likely in CP cases. Contact burns; burns involving Irons, burns Independent of the Child, Unwitnessed burns and burns to the head or trunk were more likely in CP cases than in non-CP cases.

There are a number of statistically significant differences between non-CP and CP cases that may alert ED clinicians to consider referral to social services.