Clinical Pathways
Clinical Pathways
No partial or full-thickness burns
No partial or full-thickness burns

No partial or full-thickness burns

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Action

Assess for nonaccidental burns in vulnerable populations (elderly, children)

  • Are burns well-demarcated, symmetric, and even-thickness?
  • Is mechanism inconsistent with injury?
  • Is there delay in seeking care?

Decision

Are burns nonaccidental?

Yes, nonaccidental

  • Contact adult or child protective services
  • Perform further survey for nonaccidental trauma
  • Ensure safe disposition or transfer

No, accidental

  • Provide thorough home care instructions and follow-up plan

Background

KidBits: Nonaccidental Burn Injuries in Pediatric Patients

Intentional injury must be considered in the evaluation of all pediatric burns, as well as in burned adults who are at risk for abuse due to functional limitations or disabilities. Assessing for abuse can be challenging, as scald burns are the most common type of both accidental and nonaccidental pediatric thermal burns. A systematic review of 26 retrospective studies found that symmetric appearance to wounds, clear upper wound margins, and the presence of old or apparently unrelated injuries were associated with intentional scald injuries.37^{37} Nonaccidental burns tended to involve immersion of the extremities, buttocks, or perineum, whereas accidental burns were more likely to involve the upper body. Time-to-presentation was not examined by enough high-quality studies to determine with a high degree of confidence that delayed presentation is associated with abuse; however, a 2014 single-center prospective observational study described an association between delayed presentation and nonaccidental injury.38^{38}

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References
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  27. Stewart BT, Gyedu A, Agbenorku P, et al. Routine systemic antibiotic prophylaxis for burn injuries in developing countries: A best evidence topic (BET). Int J Surg. 2015;21:168-172. (Systematic review; 2 randomized clinical trials and a retrospective cohort study)
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  32. Nowakowska MK, Li Y, Garner DC, et al. Clinical settings and demographic characteristics of patients with sunburn. JAMA Dermatol. 2021;157(9):1122-1125. (Cross-sectional study; 186,168 patients with 208,777 encounters)
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  35. Magnette J, Kienzler JL, Alekxandrova I, et al. The efficacy and safety of low-dose diclofenac sodium 0.1% gel for the symptomatic relief of pain and erythema associated with superficial natural sunburn. Eur J Dermatol. 2004;14(4):238-246. (Randomized double-blind single-center trial; 172 patients) PMID: 15319157
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