Social health outcomes following thermal injuries: A retrospective matched cohort study

Michelle Y James-Ellison ^1*, Peter Barnes ¹, Alison J Maddocks ², Kathie Wareham ³, Peter Drew ⁴, William Dickson ⁴, Ronan Lyons ⁵ and Hayley A Hutchings ⁶

¹ ABM University NHS Trust, United Kingdom
² National Public Health Service, United Kingdom
³ Clinical Research Unit, Swansea, United Kingdom
⁴ Welsh Regional Burns Unit, United Kingdom
⁵ School of Medicine, Swansea University, Wales, United Kingdom
⁶ School of Medicine, University of Wales Swansea, United Kingdom

^* To whom correspondence should be addressed. E-mail: michelle.james-ellison{at}abm-tr.wales.nhs.uk.

Accepted 14 May 2009

Abstract

Introduction: Over 50% of children admitted with burns are under 3 years. US studies suggest that up to 26% of childhood burns are non-accidental although UK reports are lower (1-16%).

Objectives: To determine the social health outcomes of burned children in terms of the number of children abused, neglected or ‘in need’ before the age of six years compared with matched controls.

Methods: A retrospective matched cohort study. One hundred and forty five burns admissions aged under 3 years between 1994 and 1997 were matched with controls for sex, age and enumeration district and followed up until 2003. Electronic routine databases provided study data on Local Authority Care episodes and Social Service Referrals by age 6 years.

Results: 89.0% were accidental burns and 4 cases (2.8%) were judged to have non-accidental burns following Child Protection Case Conference. No case was attributed to neglect. By their sixth birthday cases were statistically more likely to have been referred to Social Services with 14 (9.7%) of the burned children having been abused or neglected versus 2 (1.4%) of controls (95% CI 0.030 to 0.13, p=0.004). Forty-six (32%) of cases versus 26 (18%) controls were defined as ‘in need’ (95% CI 0.047 to 0.23, p= 0.006).

Conclusion: Although most burns were deemed accidental, 2.8% were categorised as non-accidental at presentation. Almost a third of the burned children went on to be ‘in need’. Children with a burn appear to be at higher risk of further abuse or neglect compared with controls. A burn therefore could be a surrogate marker indicating a need for closer supervision and follow up by professionals.