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Influence of agents and mechanisms of injury on anatomical burn locations in children <5 years old with a scald
  1. Assim Ali Javaid1,
  2. Emma Johnson2,
  3. Linda Hollén3,
  4. Alison Mary Kemp4
  1. 1 Department of Population Health, Cardiff University, Cardiff, UK
  2. 2 Paediatric Department, New Cross Hospital, Wolverhampton, UK
  3. 3 School of Social and Community Medicine, University of Bristol, Bristol, UK
  4. 4 Division of Population Medicine, Department of Child Health, Cardiff, UK
  1. Correspondence to Dr Assim Ali Javaid, Department of Population Health, Cardiff University, Cardiff CF10 3XQ, UK; Assimjavaid{at}


Objective To demonstrate how the mechanism and agent of injury can influence the anatomical location of a scald.

Design Prospective multicentre cross-sectional study.

Setting 20 hospital sites across England and Wales including emergency departments, minor injury units and regional burns units.

Patients Children aged 5 years and younger who attended hospital with a scald.

Main outcome measures Primary outcome: a descriptive analysis of the mechanism, agent and anatomical location of accidental scalds. Secondary outcome: a comparison of these factors between children with and without child protection (CP) referral.

Results Of 1041 cases of accidental scalds, the most common narrative leading to this injury was a cup or mug of hot beverage being pulled down and scalding the head or trunk (132/1041; 32.9% of cases). Accidental scalds in baths/showers were rare (1.4% of cases). Accidental immersion injuries were mainly distributed on hands and feet (76.7%). There were differences in the presentation between children with accidental scalds and the 103 who were referred for CP assessment; children with scalds caused by hot water in baths/showers were more likely to get referred for CP assessment (p<0.0001), as were those with symmetrically distributed (p<0.0001) and unwitnessed (p=0.007) scalds.

Conclusions An understanding of the distributions of scalds and its relationship to different mechanisms of injury and causative agents will help clinicians assess scalds in young children, particularly those new to the emergency department who may be unfamiliar with expected scald patterns or with the importance of using appropriate terminology when describing scalds.

  • epidemiology
  • child abuse

Data availability statement

Data may be obtained from a third party and are not publicly available. For data access enquiries, please contact Professor Alison Kemp.

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Data availability statement

Data may be obtained from a third party and are not publicly available. For data access enquiries, please contact Professor Alison Kemp.

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  • Contributors AAJ (lead author): writing article and data analysis. EJ: writing abstract, literature review, article review and reference organisation. LH: data analysis and article review. AMK: supervision of article and study design.

  • Funding This study was supported by the Scar Free Foundation and Health and Care Research Wales.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.