Contact Burns: The Influence of Agents and Mechanisms of Injury on Anatomical Burn Locations in Children <5 Years Old and Associations with Child Protection Referrals

Objective: To identify how causative agents and mechanisms of injury influence the location of an accidental contact burn in children and whether these factors differ in cases referred for child protection (CP) assessment. Design: Prospective multicentre cross-sectional study. Setting 20 hospital sites across England and Wales, including: emergency departments, minor injury units and regional burn units. Patients: Children less than 5 years old who attended hospital for a contact burn (August 2015 to September 2018). Main outcome measures: Location of burns with respect to agent and mechanism for accidental contact burns. Secondary outcome: mechanism, agent and location of burns referred for CP assessment. Results: 816 accidental burns and 92 referrals for CP assessment. The most common for accidental burns: mechanism was reaching while stationary (68%, 553/816), agent was oven (24.5%, 200/816) and site was the hand (69.2%, 565/816). Burns to head and trunk were rare at 3.7% (30/816). The data enabled a tabulation of the locations of burns as predicted by agent and mechanism of injury. The location of the burn was most strongly influenced by mechanism. Burns from irons (p<0.01), caused by mechanisms independent of the child (p=0.01), unwitnessed burns (p<0.001) and burns to the head and trunk (p<0.001) were significantly more common among the children referred for CP assessment. Conclusions: By overlaying agent, mechanism and site it was possible to tabulate and quantify simple narratives of accidental contact burns in population of young children. These findings have the potential to aid clinicians in recognising accidental contact burns.