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.