Burns as Child Abuse: Risk Factors and Legal Issues in West Texas and Eastern New Mexico

Abstract

The purpose of this study were to describe risk factors for child abuse from burns and examine prosecution and conviction rates after case discussions at a multidisciplinary conference Retrospective cohort study of all pediatric burns admitted between 2001 and 2006 was performed. Registry data on age, sex, mechanism, location, and size of burn were recorded. Registry data were verified against nursing documentation for accuracy. All cases were reviewed at the multidisciplinary “care conference” to gather insight from various perspectives to make a final determination of abuse or neglect. Bivariate and multivariate analysis was used to identify factors associated with child abuse. Prosecution rates were determined by contacting child protective services and district attorney's offices. A total of 457 children were included in the analysis. Most of the children were boys (70%) and were of Hispanic origin (57%), with 30% white and 10% black. Hundred cases were suspicious for abuse after review at care conference. Younger age was a significant risk factor (OR: 0.73, 95% CI: 0.65–0.82), with the mean age of abused children being 1 ¾ years compared with 5 ½ years for accidental injuries. Girls were at higher risk for abuse (OR: 1.76, 95% CI: 1.06–2.91).Torso injuries were significantly more common in abused children, an unusual finding possibly reflecting a different abuse pattern in infants compared with toddlers. Suspected abuse resulted in longer hospital stays (OR: 1.03, 95% CI: 1.01–1.07). Prosecution rates and conviction rates in the authors region are low, at only 26 and 11% of suspicious cases, respectively. Young age and female sex were positively correlated with child abuse. Prosecution and conviction rates are remarkably low, despite using a multidisciplinary care conference to review all cases and obtaining early involvement of child protective services and law enforcement.