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Playing with fire: missed opportunities in the referral and follow-up to pre-school burns
  1. B Saunders,
  2. A M Kemp,
  3. S Maguire
  1. Department of Child Health, Cardiff University School of Medicine, Cardiff, UK

Abstract

Aims Every year in the UK, 50 000 children <5 years sustain burns. Health visitor (HV) follow-up after injury attendances to emergency departments (ED) significantly reduces further injury, improves home safety practices and reduces hazards, and may identify potential safeguarding concerns. We evaluated ED burns referrals to HV, to identify what follow-up occurs and the factors influencing this decision.

Methods All pre-school burn attendances to a University Hospital ED (August 2008–August 2009) were identified. A postal questionnaire was sent to HVs, supplemented with telephone interview. χ2, Student's t test and OR at 95% CI were performed.

Results Of 176 cases identified, 140 questionnaires were sent (25 outside catchment, 11 no available records) and 97 (69%) responded. There were no significant differences in burn type and severity between responders and non-responders, although responders patients were younger (13.7 vs 22.3 months, two-sample t (138)=3.76, p<0.001). Among responders, scalds accounted for 57%, the commonest agent was hot drinks (39%) followed by hair straighteners (14%). The ED notified HVs in 82% of cases. Information in the referral varied greatly: 90% detailed the burn agent, 68% the burn mechanism and 40% whether the child was supervised. Half the cases were followed-up by a HV, 30% by home visit. Knowledge of the family, routine follow-up, the age of the child and severity of the burn were the main reasons given by HVs for deciding to follow-up. However only increased percentage burn surface area (two-sample t (88)=2.15, p=0.034) and ‘burns follow-up was routine’ (OR=3.54, 95% CI 1.30 to 9.70) were actually associated with a home visit. After knowledge of the family, caseload (15%) and ambiguous or absent referrals (15%) were the commonest reasons given for not following-up.

Conclusions Despite a policy to refer all burns cases, almost a fifth are not referred and vital information is often omitted; only half of cases are followed-up. Making burns follow-up routine and improving inter-professional communication may reduce the risk of missing these important follow-up opportunities. Further studies should identify other ways of improving follow-up and maximizing the impact of burn prevention advice.

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