@article{ref1,
title="Evaluation of the efficacy and impact of a clinical prediction tool to identify maltreatment associated with children's burns",
journal="BMJ paediatrics open",
year="2021",
author="Hollén, Linda and Bennett, Verity and Nuttall, Dianne and Emond, Alan M. and Kemp, Alison",
volume="5",
number="1",
pages="e000796-e000796",
abstract="BACKGROUND: An estimated 10%-24% of children attending emergency departments with a burn are maltreated. <br><br>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. <br><br>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. <br><br>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. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="2399-9772",
doi="10.1136/bmjpo-2020-000796",
url="http://dx.doi.org/10.1136/bmjpo-2020-000796"
}