Citation

Reading R. Child Care Health Dev. 2009; 35(1): 142.

Copyright

(Copyright © 2009, John Wiley and Sons)

DOI

10.1111/j.1365-2214.2008.00921_4.x

PMID

unavailable

Abstract

Background  Most intentional burns are scalds, and distinguishing these from unintentional causes is challenging.

Aim  To conduct a systematic review to identify distinguishing features of intentional and unintentional scalds.

Methods  We performed an all language literature search of 12 databases 1950–2006. Studies were reviewed by two paediatric/burns specialists, using standardized methodology. Included: Primary studies of validated intentional or accidental scalds in children 0–18 years old and ranked by confirmation of intentional or unintentional origin. Excluded: Neglectful scalds; management or complications; studies of mixed burn type or mixed adult and child data.

Results  A total of 258 studies were reviewed, and 26 included. Five comparative studies ranked highly for confirmation of intentional/unintentional cause of injury. The distinguishing characteristics were defined based on best evidence. Intentional scalds were commonly immersion injuries, caused by hot tap water, affecting the extremities, buttocks or perineum or both. The scalds were symmetrical with clear upper margins, and associated with old fractures and unrelated injuries. Unintentional scalds were more commonly due to spill injuries of other hot liquids, affecting the upper body with irregular margins and depth.

Conclusions  We propose an evidence‐based triage tool to aid in distinguishing intentional from unintentional scalds, requiring prospective validation.