Diagnostic accuracy of a clinical prediction tool (BuRN-Tool) to identify maltreatment associated with burns in children
To investigate the diagnostic accuracy and utility of the BuRN-Tool (Burns Risk assessment for Neglect or abuse Tool), a Clinical Prediction Tool (CPT) to help clinicians identify maltreatment in children who are seen in the Emergency Department (ED) with burns.
The BuRNTool is a validated CPT of seven simple indicators, each has a numerical score that when summated produce a total score between 0-12. A score of three or more has an increased likelihood of maltreatment (neglect or physical abuse), and prompts the healthcare professional to follow child safeguarding procedures.
The study will evaluate whether the BuRN-Tool improves the recognition of children who require a safeguarding action from Children's Social Care (CSC).
Investigation plan: A two-year controlled before and after study in five intervention centres. Children from a sixth centre that does not receive the intervention will act as normative controls to monitor background trends over time.
Target population: is children 16 years old attending with burns. For nine months, clinicians in the five intervention centres will collect demographic and clinical data during routine assessment of an estimated 1000 children using a standardised clinical assessment; the BaSAT (Burns and Scalds Assessment Template) before the BuRN-Tool is introduced.
Intervention: The BuRN-Tool will be added to the BaSAT and applied for a further nine months (estimated 1000 children) in the five intervention centres. The clinicians will derive a total score for each child and take the appropriate safeguarding action. The normative control centre will collect data using the BaSAT throughout the data collection period in an attempt to identify unforeseen baseline trends over time.
The primary outcome: will be safeguarding action taken by CSCs (e.g. outcome of Section 17 or 47 assessment, or onward referral to other agency for family support). We will compare the actions taken by CSC with and without the BuRN-Tool in the five intervention centres and between intervention and the normative control centre. These data will be sought for all children in all six centres from ED records and Local Authority CSC departments six months after the original presentation to ED.
Secondary outcomes include: the diagnostic accuracy of the BuRN-Tool, actions taken by clinicians with respect to individual BuRN-Tool scores categorised into: discussed with senior colleague, referral to health visitor (HV), discussed with hospital safeguarding team or referred to CSC for assessment.
Process evaluation; qualitative data will be collected from parents, ED staff, health visitors and CSC staff about the benefits and limitations of the BuRN-Tool in clinical practice and social care to explore whether the BuRN-Tool is perceived as beneficial.
Benefits for the public and patients: at least one in 10 children who sustain burns do so as a result of maltreatment. The BuRN-Tool is a simple CPT that can be applied easily in ED to recognise these children so that support can be provided for them and their families to optimise their future health and wellbeing.
If effective the BuRN-Tool has the potential for widespread introduction across the NHS. Child abuse and neglect are 'Adverse Childhood Experiences' (ACEs) and strongly associated with future violence victimisation and lifelong adverse health and poor opportunities. The future health and wellbeing of the public will benefit if ACEs are recognised and acted upon early.