Raising suspicion of maltreatment from burns: Derivation and validation of the BuRN-Tool

• Published in: Burns 2018-03, Vol.44 (2), p.335-343
• Main Authors: Kemp, Alison M., Hollén, Linda, Emond, Alan M., Nuttall, Diane, Rea, David, Maguire, Sabine
• Format: Article
• Language: English
• Subjects: Age Factors; Burn; Burns - etiology; Child; Child Abuse - diagnosis; Child Protective Services; Child, Preschool; Clinical prediction tool; Decision Support Techniques; Female; Humans; Infant; Logistic Models; Male; Maltreatment; Multivariate Analysis; Referral and Consultation; Reproducibility of Results; ROC Curve; Sensitivity and Specificity; Trauma Severity Indices
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2017.08.018

•The BuRN-Tool; a validated clinical prediction to identify children with suspected maltreatment.•The score is simple and easy to complete in an emergency department setting.•It has a sensitivity of 84% (71.5–91.6) and specificity of 80% (77.0–82.9).•The BuRN-Tool is an adjunct to decision-making, to predict children at risk for maltreatment. 10–25% of childhood burns arise from maltreatment. To derive and validate a clinical prediction tool to assist the recognition of suspected maltreatment. Prospectively collected data from 1327 children with burns were analyzed using logistic regression. Regression coefficients for variables associated with ‘referral for child maltreatment investigation’ (112 cases) in multivariable analyses were converted to integers to derive the BuRN-Tool, scoring each child on a continuous scale. A cut-off score for referral was established from receiver operating curve analysis and optimal sensitivity and specificity values. We validated the BuRN-Tool on 787 prospectively collected novel cases. Variables associated with referral were: age