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Contact, Cigarette and Flame Burns in Physical Abuse: A Systematic Review

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Abstract

This systematic review identifies features of intentional non-scald burns in physical abuse. Fifteen bibliographic databases of international literature (1950–2011) were searched to identify potential studies that were critically appraised using standardised methods. Primary studies with confirmed intentional non-scald burns in children aged < 18 years were included to provide a descriptive analysis of the causation, appearance and distribution of burns.

‘This systematic review identifies features of intentional non-scald burns in physical abuse’

Twenty studies were included: one cross-sectional, one case control and 18 case studies/small case series representing 73 children with intentional non-scald burns. The majority were contact burns from household items: the agents included cigarettes (18), irons (9), electric fires/heaters/radiators (10), cigarette lighters (2), hairdryers (7), curling tongs (3), chemicals (3), microwaves (2) flame burns (7), miscellaneous (7) and burns of unknown cause (5). The burns occurred throughout childhood. The majority of children were older than three years. The characteristic features were of clearly demarcated contact burns or scars in shapes that mirrored the agent. They were predominantly recorded on the limbs, trunks and the backs of hands; they were frequently multiple and co-existed with additional signs of abuse. These features should raise concerns of suspected physical abuse. Copyright © 2013 John Wiley & Sons, Ltd.

Key Practitioner Messages

Intentional Non-scald Burns

  • The commonest reported cause of intentional non-scald burns are contact burns: cigarettes, irons, hairdryers or domestic heaters.
  • Burns are often clearly demarcated in the shape of the causative agent.
  • Burns are found on the limbs, back or trunk, in locations other than the palms of the hands.
  • Burns are often multiple and may co-exist with other injuries suspicious of abuse.
  • Single or multiple circular, deep-cratered burns are consistent with cigarette burns.

‘The commonest reported cause of intentional non-scald burns are contact burns’

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