Patient and injury characteristics, mortality risk, and length of stay related to child abuse by burning: evidence from a national sample of 15,802 pediatric admissions.

OBJECTIVE: To report demographic and injury characteristics of children admitted to burn centers with injuries from suspected child abuse and to assess mortality risk and length of stay compared with patients whose injuries were labeled accidental. SUMMARY BACKGROUND DATA: Little is known about the association between burn injuries from suspected child abuse, mortality, and length of hospitalization.
METHODS: Records from 15,802 pediatric admissions (909 with suspected abuse) to 70 burn centers from the American Burn Association National Burn Repository were reviewed. Multivariable logistic regression and Cox regression models were used to assess the relationship between suspected abuse with mortality and length of intensive care and total hospital stays after controlling for age, sex, race, burn etiology (flame vs. scald or contact), % total body surface area burned, and inhalation injury.
RESULTS: Children with injuries from abuse were younger (2.4 years vs. 3.9 years, P < 0.001), had larger total body surface area burned (13.0% vs. 9.7%, P < 0.001) and were more likely to incur a scald injury (78.0% vs. 59.2%, P < 0.001). After adjusting for covariates, children with suspected abuse-related injuries were at greater risk of mortality (odds ratio = 4.67, CI = 2.60-8.39, P < 0.001) and required longer intensive care (hazard ratio for discharge [HR] = 0.93, CI = 0.87-1.00, P = 0.044) and total hospital stays (HR = 0.60, CI = 0.56-0.64, P < 0.001).
CONCLUSIONS: Compared with children with accidental burn injuries who had similar demographic and injury characteristics, children admitted to burn centers with suspected abuse were at greater risk of mortality and required longer intensive care and total hospital stays.