Does the BuRN‐Tool Score Correctly Predict Cases of Maltreatment in Children Referred for a Child Protection Medical Assessment?. (28th May 2021)

• Record Type: Journal Article
• Authors: Evans, Eleanor J.; Bennett, C. Verity; Hollén, Linda; Nuttall, Diane; Kemp, Alison; Mullen, Stephen
• Is Part Of: Child abuse review. Volume 30:Number 6(2021)
• Page Start: 565
• Page End: 575
• Publication Date: 2021-05-28
• Subjects: burns -- paediatrics -- paediatric emergency medicine -- paediatric injury -- non‐accidental injury; Child abuse -- Periodicals; Child abuse -- Great Britain -- Periodicals; Abused children -- Services for -- Periodicals; Abused children -- Services for -- Great Britain -- Periodicals; 362.76
• DOI: 10.1002/car.2668
• Languages: English
• ISSNs: 0952-9136

Abstract

Abstract : The BuRN‐Tool is a clinical prediction tool designed to indicate child protection (CP) concerns for children attending the emergency department with a burn. Eight weighted factors contribute to a summative score between 0 and 12, a score ≥3 indicates a CP concern. In order to test agreement of the BuRN‐Tool score with CP concern and with the social care CP outcome, it was applied retrospectively to 52 children referred for a CP medical evaluation following a burn. Data were collected from case notes using a purpose‐designed proforma and a score calculated for each. Outcomes were classified as 'maltreatment‐probable' ('physical abuse' or 'neglect') or 'maltreatment‐unlikely', according to social care CP outcomes. The BuRN‐Tool correctly identified 49/52 (94.2%) as a CP concern, with scores significantly higher in 'maltreatment‐probable' ( n = 17) than 'maltreatment‐unlikely' cases ( n = 35, p = 0.01). Scores for 'maltreatment‐unlikely' were lower (median [IQR]: 5 [4–7]) than for maltreatment likely for 'physical abuse' cases (median [IQR]: 8 [7–9]; p = 0.005). 'Maltreatment unlikely' scores did not differ from 'neglect' scores (median [IQR]: 7 [5–7]; p = 0.14), a non‐parametric trend test confirmed a significant increase in scores across the three ordered groups ( p = 0.003). The BuRN‐Tool is not a diagnostic, but a screening tool. Consistent with their referral for a CP evaluation, the majority of children scored >3 on the BuRN‐Tool. However, for children where 'maltreatment was probable' the BuRN‐Tool scores were higher. Key Practitioner Messages: The BuRN‐Tool correctly classified 49/52 children who were referred to a CP medical team with a CP concern for assessment following a burn. Cases with an outcome of 'maltreatment‐probable' had a significantly higher BuRN‐Tool score than those where maltreatment was deemed unlikely. The highest BuRN‐Tool scores had the potential to distinguish injuries caused by physical abuse from those where maltreatment was unlikely.