Burns as child abuse: risk factors and legal issues in West Texas and Eastern New Mexico.

The purpose of this study were to describe risk factors for child abuse from burns and examine prosecution and conviction rates after case discussions at a multidisciplinary conference Retrospective cohort study of all pediatric burns admitted between 2001 and 2006 was performed. Registry data on age, sex, mechanism, location, and size of burn were recorded. Registry data were verified against nursing documentation for accuracy. All cases were reviewed at the multidisciplinary "care conference" to gather insight from various perspectives to make a final determination of abuse or neglect. Bivariate and multivariate analysis was used to identify factors associated with child abuse. Prosecution rates were determined by contacting child protective services and district attorney's offices. A total of 457 children were included in the analysis. Most of the children were boys (70%) and were of Hispanic origin (57%), with 30% white and 10% black. Hundred cases were suspicious for abuse after review at care conference. Younger age was a significant risk factor (OR: 0.73, 95% CI: 0.65-0.82), with the mean age of abused children being 1 (3/4) years compared with 5 (1/2) years for accidental injuries. Girls were at higher risk for abuse (OR: 1.76, 95% CI: 1.06-2.91).Torso injuries were significantly more common in abused children, an unusual finding possibly reflecting a different abuse pattern in infants compared with toddlers. Suspected abuse resulted in longer hospital stays (OR: 1.03, 95% CI: 1.01-1.07). Prosecution rates and conviction rates in the authors region are low, at only 26 and 11% of suspicious cases, respectively. Young age and female sex were positively correlated with child abuse. Prosecution and conviction rates are remarkably low, despite using a multidisciplinary care conference to review all cases and obtaining early involvement of child protective services and law enforcement.

Cooking-related pediatric burns: risk factors and the role of differential cooling rates among commonly implicated substances.

Cooking-related injuries are a common problem worldwide, resulting in more pediatric burns than any other cause. We identified risk factors-associated mechanisms and determined cooling curves for common substances. A retrospective review of children admitted to a Level I burn center between 2001 and 2006 was performed. Variables including injury mechanism, age, sex, race, burn area, length of stay, and outcome were recorded. Commonly implicated substances were identified, and cooling curves for each were measured at room temperature. Logistic regression analysis was performed to identify risk factors for cooking injury. A total of 541 pediatric burn patients were admitted, of whom 123 had cooking-related injuries. Common substances involved included soup (27%), grease (26%), coffee (18%), beans (9%), and menudo (2.3%), a traditional Mexican soup based on tripe, hominy, and chile. Children with cooking injuries were significantly younger than other groups, with a mean age of 2.7 years. The most common mechanism was the child pulling the substance down from a height, accounting for nearly half of all injuries. This resulted in a characteristic scald pattern involving a wide area across chest and shoulders narrowing to a point near the pelvis. The average burn area was 7%, associated with a hospital stay of 4 days and mortality below 1%. Analysis of cooling curves revealed surprising variation in heat retention, with semisolid or high-density liquids posing a markedly increased burn risk. Cooking injuries predominantly affect toddlers, with clearly recognized mechanisms and risk factors. Injury prevention measures should be targeted accordingly.