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

Hollen, Linda, Bennett, Verity ORCID: https://orcid.org/0000-0002-9311-4124, Nuttall, Dianne, Emond, Alan M and Kemp, Alison ORCID: https://orcid.org/0000-0002-1359-7948 2021. Evaluation of the efficacy and impact of a clinical prediction tool to identify maltreatment associated with children’s burns. BMJ Paediatrics Open 5 (1) , e000796. 10.1136/bmjpo-2020-000796

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Abstract

Background An estimated 10%–24% of children attending emergency departments with a burn are maltreated. Objective To test whether a clinical prediction tool (Burns Risk assessment for Neglect or abuse 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 (2015–2018), each centre providing a minimum of 200 cases before and after the introduction of the BuRN-Tool. The proportions of children referred to safeguarding services were compared preintervention and postintervention, 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. After 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 <3 (65.3% vs 13.4%, p<0.001). There was no overall difference in the proportion of safeguarding referrals preintervention and postintervention. After 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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Publisher:	BMJ Publishing Group
ISSN:	2399-9772
Date of First Compliant Deposit:	22 February 2021
Date of Acceptance:	3 December 2020
Last Modified:	13 May 2023 07:31
URI:	https://orca.cardiff.ac.uk/id/eprint/138670

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