Alison M Kemp1, Linda Hollén2, Alan M Emond2, Diane Nuttall3, David Rea4, Sabine Maguire3. 1. School of Medicine, Cardiff University, United Kingdom. Electronic address: kempam@cardiff.ac.uk. 2. School of Social and Community Medicine, University of Bristol, United Kingdom. 3. School of Medicine, Cardiff University, United Kingdom. 4. University of the West of England, Bristol, United Kingdom.
Abstract
BACKGROUND: 10-25% of childhood burns arise from maltreatment. AIM: To derive and validate a clinical prediction tool to assist the recognition of suspected maltreatment. METHODS: Prospectively collected data from 1327 children with burns were analyzed using logistic regression. Regression coefficients for variables associated with 'referral for child maltreatment investigation' (112 cases) in multivariable analyses were converted to integers to derive the BuRN-Tool, scoring each child on a continuous scale. A cut-off score for referral was established from receiver operating curve analysis and optimal sensitivity and specificity values. We validated the BuRN-Tool on 787 prospectively collected novel cases. RESULTS: Variables associated with referral were: age <5years, known to social care, concerning explanation, full thickness burn, uncommon body location, bilateral pattern and supervision concern. We established 3 as cut-off score, resulting in a sensitivity and specificity for scalds of 87.5% (95% CI:61.7-98.4) and 81.5% (95% CI:77.1-85.4) respectively and for non-scalds sensitivity was 82.4% (95%CI:65.5-93.2) and specificity 78.7% (95% CI:73.9-82.9) when applied to validation data. Area under the curve was 0.87 (95% CI:0.83-0.90) for scalds and 0.85 (95% CI:0.81-0.88) for non-scalds. CONCLUSION: The BuRN-Tool is a potential adjunct to clinical decision-making, predicting which children warrant investigation for child maltreatment. The score is simple and easy to complete in an emergency department setting.
BACKGROUND: 10-25% of childhood burns arise from maltreatment. AIM: To derive and validate a clinical prediction tool to assist the recognition of suspected maltreatment. METHODS: Prospectively collected data from 1327 children with burns were analyzed using logistic regression. Regression coefficients for variables associated with 'referral for child maltreatment investigation' (112 cases) in multivariable analyses were converted to integers to derive the BuRN-Tool, scoring each child on a continuous scale. A cut-off score for referral was established from receiver operating curve analysis and optimal sensitivity and specificity values. We validated the BuRN-Tool on 787 prospectively collected novel cases. RESULTS: Variables associated with referral were: age <5years, known to social care, concerning explanation, full thickness burn, uncommon body location, bilateral pattern and supervision concern. We established 3 as cut-off score, resulting in a sensitivity and specificity for scalds of 87.5% (95% CI:61.7-98.4) and 81.5% (95% CI:77.1-85.4) respectively and for non-scalds sensitivity was 82.4% (95%CI:65.5-93.2) and specificity 78.7% (95% CI:73.9-82.9) when applied to validation data. Area under the curve was 0.87 (95% CI:0.83-0.90) for scalds and 0.85 (95% CI:0.81-0.88) for non-scalds. CONCLUSION: The BuRN-Tool is a potential adjunct to clinical decision-making, predicting which children warrant investigation for child maltreatment. The score is simple and easy to complete in an emergency department setting.
Authors: Gunjan Tiyyagura; Andrea G Asnes; John M Leventhal; Eugene D Shapiro; Marc Auerbach; Wei Teng; Emily Powers; Amy Thomas; Daniel M Lindberg; Justin McClelland; Carol Kutryb; Thomas Polzin; Karen Daughtridge; Virginia Sevin; Allen L Hsiao Journal: Acad Pediatr Date: 2021-11-12 Impact factor: 2.993
Authors: Akshaya V Annapragada; Marcella M Donaruma-Kwoh; Ananth V Annapragada; Zbigniew A Starosolski Journal: PLoS One Date: 2021-02-26 Impact factor: 3.240
Authors: Jill R McTavish; Andrea Gonzalez; Nancy Santesso; Jennifer C D MacGregor; Chris McKee; Harriet L MacMillan Journal: BMC Pediatr Date: 2020-03-07 Impact factor: 2.125