An evaluation of the efficacy and impact of a clinical prediction tool to identify maltreatment associated with children’s burns

Background: An estimated 10-24% of children attending emergency departments with a burn are maltreated. Objective: To test whether a clinical prediction tool (BuRN-Tool) improved the recognition of maltreatment and increased the referral of high-risk children to safeguarding services for assessment. Methods: A prospective study of children presenting with burns to four UK hospitals (2015-18) each centre providing a minimum of 200 cases before and after introduction of the BuRNTool. The proportion of children referred to safeguarding services were compared pre and post intervention, and the relationship between referral and the recommended cut-off for concern (BuRN-Tool score BT-score ≥ 3) was explored. Results: The sample was 2443 children (median age 2 years). Nurses and junior doctors mainly completed the BuRN-Tool, and a BT-score was available for 90.8% of cases. Post intervention, 28.4% (334/1174) had a BT-score ≥ 3 and were nearly five times more likely to be discussed with a senior clinician than those with a BT-score of < 3 (65.3% versus 13.4%, p<0.001). There was no overall difference in the proportion of safeguarding referrals pre and post intervention. Post intervention, the proportion of referrals for safeguarding concerns was greater when the BT-score was ≥3 (p=0.05) but not for scores <3 (p=0.60). A BT-score of 3 as a cut-off for referral had a sensitivity of 72.1, a specificity of 82.7 and a positive likelihood ratio of 4.2. Conclusions: A BT-score ≥3 encouraged discussion of cases of concern with senior colleagues and increased the referral of < 5-year-olds with safeguarding concerns to children’s social care.