Do paediatric patients with suspected non-accidental burn injuries have worse clinical outcomes? A 5-year retrospective review from a UK burns centre.

Abstract

Burns are a very common reason for attendance and admission of children to hospital. Non-accidental injury (NAI) and child protection concerns (CP) are crucially important in paediatric burns presentations - prevalence in the UK is reported between 5 % and 14 %. This range reflects challenges in identifying suspicious injuries, as well as the underlying geographic and socioeconomic variations in practice. This study examines the demographics, management, and outcomes of paediatric burns admissions with NAI or CP concerns in a UK burns centre. Retrospective analysis of all acute paediatric burns and thermal injury patients admitted at the Royal Hospital for Children, Glasgow 2018-2022 inclusive. 594 eligible patients were identified, with a mean age of 4.67 years, a mean % total body surface area burn (%TBSA) of 3.65 % and scald burns being the most common mechanism (59.3 %). The majority of patients (84.2 %) were managed conservatively. 94 (15.8 %) patients had concerns relating to CP issues or potential NAI during their admission. These patients were more likely to have larger %TBSA injuries (P < 0.001), to have a longer duration of admission (P < 0.001) and to be from a more socioeconomically disadvantaged background (P = 0.007). There was no statistically significant difference in mean age, need for surgery, positive microbiology, antibiotic use and duration of follow up. The prevalence of NAI/CP concerns in our series was higher than the UK mean, possibly reflecting socioeconomic disparities. Suspected NAI cases were not associated with worse clinical outcomes. We recommend that individual burn services examine their own patient cohorts to determine NAI prevalence and interpret these findings in the context of their geography and socioeconomic composition. A primary focus of teams treating paediatric burn patients should be on prompt recognition of suspicious injuries, escalation through local safeguarding channels, and influencing public health prevention policies, where applicable.