NIHR Signal Young children from deprived areas are more at risk of serious burns and scalds

Published on 24 January 2017

Five in every 1,000 children under four are injured by burns and scalds each year in England, although these injuries are becoming less common. Serious injuries needing hospital treatment happen more often to children from deprived areas than wealthy areas.

The study looked at general practice data from 1998 to 2013. It showed a steady decline in children having burns and scalds over the 15 year period, and the gap between least- and most-deprived areas has narrowed. However, children from the most deprived areas are more than twice as likely to need hospital treatment. Children aged 15 to 17 months are most at risk.

Most burns and scalds are preventable. The findings suggest that programmes to prevent these injuries should be targeted at deprived areas, to reduce the devastating effect of serious burns on young children’s lives.

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Why was this study needed?

In 2014, Public Health England named prevention of burns and scalds in young children as one of its five priority areas. Burns and scalds can be expensive to treat (e.g. £173k for a single serious bathwater scald), and can cause life-altering physical and psychological disabilities, as well as significant pain and distress to the child and family.

Existing studies estimate that there are between 21 and 31 burns or scalds for every 10,000 children at all ages in high income countries, with three to nine of them needing hospital treatment.

Public health practitioners and commissioners need to understand who is at highest risk of injury so that they can target their preventive strategies more effectively. This study used long-term data to identify trends in injuries, age and gender of children injured, and their socioeconomic background.

What did this study do?

Researchers used data from the UK’s Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics to identify burns and scalds reported among children under five, from 1998 to 2013. They had information on 708,050 children, who between them had 11,406 burn or scald injuries.

Burns related to chemicals or corrosive agents were not included. To avoid counting the same injury more than once, researchers excluded records of injuries close together in time.

They carried out analyses to estimate the incidence of burns and scalds by age, gender, socioeconomic status and calendar time.

The CPRD is not used by all GP practices. Proportionally fewer practices are registered in the North East, East Midlands, and Yorkshire and Humber, meaning the results may underestimate events in these regions.

What did it find?

  • Overall, there were 59.5 burns or scalds for every 10,000 children per year during the period 1998 to 2014 (95% confidence interval [CI] 58.4 to 60.6). This fell from 81.3 for every 10,000 children per year in 1998/99 (95% CI 75.9 to 87.0) to 50 for every 10,000 children per year in 2012/13 (95% CI 47.5 to 52.5).
  • Children were at highest risk of injury when aged 15 to 17 months, with 130.7 injuries for every 10,000 children per year at this age (95%CI 123.9–138.0). Boys were 20% more likely to be injured than girls (incident rate ratio for girls 0.80, 95% CI 0.77 to 0.83).
  • Children from the most deprived areas were 60% more likely to have burn and scald injuries than those from the least deprived areas in the period 2010 to 2013 (incident rate ratio 1.6, CI not shown). The difference in risk increased with the severity of burn: children from most deprived areas were 2.5 times more likely to have hospital treatment for a burn or scald in 2010 to 2013 than the least deprived (incidence ratio 2.54, CI not shown).

What does current guidance say on this issue?

NICE published guidance on prevention of unintentional injury at home for under-15s in 2010 (reviewed in 2014).

The main recommendation is for those responsible for public health to identify households at greatest risk. These households should be offered home safety assessments, and supplied with appropriate safety equipment (e.g. cupboard locks, smoke alarms, mixer taps).

NICE also recommends a coordinated effort between health workers, emergency services, and local authorities to deliver continued assessments and injury prevention programmes.

Additionally, further home safety checks should be integrated into other visits from social workers, GPs and midwives.

What are the implications?

Although the numbers of young children suffering burns and scalds have decreased, these preventable injuries still happen too often. Given the high rate of serious injuries in children from deprived areas shown in this study, injury prevention programmes should be targeted at these households.

Prevention programmes should be a collaboration between agencies (e.g. public health teams, health visitors, fire services), and should include home safety schemes and provision of safety equipment.

Citation and Funding

Baker R, Tata L, Kendrick D, et al. Differing patterns in thermal injury incidence and hospitalisations among 0–4 year old children from England. Burns.2016;42(7):1609–16.

This project was funded by the National Institute for Health Research School for Primary Care Research and The University of Nottingham.

Bibliography

NICE CKS. Burns and scalds. London: National Institute for Health and Care Excellence Clinical Knowledge Summaries; 2015.

NHS Choices. Burns and scalds – prevention. London: Department of Health; 2015.

NICE. Unintentional injuries in the home: prevention strategies for under 15s. PH30. London: National Institute for Health and Care Excellence; 2010.

Why was this study needed?

In 2014, Public Health England named prevention of burns and scalds in young children as one of its five priority areas. Burns and scalds can be expensive to treat (e.g. £173k for a single serious bathwater scald), and can cause life-altering physical and psychological disabilities, as well as significant pain and distress to the child and family.

Existing studies estimate that there are between 21 and 31 burns or scalds for every 10,000 children at all ages in high income countries, with three to nine of them needing hospital treatment.

Public health practitioners and commissioners need to understand who is at highest risk of injury so that they can target their preventive strategies more effectively. This study used long-term data to identify trends in injuries, age and gender of children injured, and their socioeconomic background.

What did this study do?

Researchers used data from the UK’s Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics to identify burns and scalds reported among children under five, from 1998 to 2013. They had information on 708,050 children, who between them had 11,406 burn or scald injuries.

Burns related to chemicals or corrosive agents were not included. To avoid counting the same injury more than once, researchers excluded records of injuries close together in time.

They carried out analyses to estimate the incidence of burns and scalds by age, gender, socioeconomic status and calendar time.

The CPRD is not used by all GP practices. Proportionally fewer practices are registered in the North East, East Midlands, and Yorkshire and Humber, meaning the results may underestimate events in these regions.

What did it find?

  • Overall, there were 59.5 burns or scalds for every 10,000 children per year during the period 1998 to 2014 (95% confidence interval [CI] 58.4 to 60.6). This fell from 81.3 for every 10,000 children per year in 1998/99 (95% CI 75.9 to 87.0) to 50 for every 10,000 children per year in 2012/13 (95% CI 47.5 to 52.5).
  • Children were at highest risk of injury when aged 15 to 17 months, with 130.7 injuries for every 10,000 children per year at this age (95%CI 123.9–138.0). Boys were 20% more likely to be injured than girls (incident rate ratio for girls 0.80, 95% CI 0.77 to 0.83).
  • Children from the most deprived areas were 60% more likely to have burn and scald injuries than those from the least deprived areas in the period 2010 to 2013 (incident rate ratio 1.6, CI not shown). The difference in risk increased with the severity of burn: children from most deprived areas were 2.5 times more likely to have hospital treatment for a burn or scald in 2010 to 2013 than the least deprived (incidence ratio 2.54, CI not shown).

What does current guidance say on this issue?

NICE published guidance on prevention of unintentional injury at home for under-15s in 2010 (reviewed in 2014).

The main recommendation is for those responsible for public health to identify households at greatest risk. These households should be offered home safety assessments, and supplied with appropriate safety equipment (e.g. cupboard locks, smoke alarms, mixer taps).

NICE also recommends a coordinated effort between health workers, emergency services, and local authorities to deliver continued assessments and injury prevention programmes.

Additionally, further home safety checks should be integrated into other visits from social workers, GPs and midwives.

What are the implications?

Although the numbers of young children suffering burns and scalds have decreased, these preventable injuries still happen too often. Given the high rate of serious injuries in children from deprived areas shown in this study, injury prevention programmes should be targeted at these households.

Prevention programmes should be a collaboration between agencies (e.g. public health teams, health visitors, fire services), and should include home safety schemes and provision of safety equipment.

Citation and Funding

Baker R, Tata L, Kendrick D, et al. Differing patterns in thermal injury incidence and hospitalisations among 0–4 year old children from England. Burns.2016;42(7):1609–16.

This project was funded by the National Institute for Health Research School for Primary Care Research and The University of Nottingham.

Bibliography

NICE CKS. Burns and scalds. London: National Institute for Health and Care Excellence Clinical Knowledge Summaries; 2015.

NHS Choices. Burns and scalds – prevention. London: Department of Health; 2015.

NICE. Unintentional injuries in the home: prevention strategies for under 15s. PH30. London: National Institute for Health and Care Excellence; 2010.

Differing patterns in thermal injury incidence and hospitalisations among 0–4 year old children from England

Published on 1 November 2016

R Baker, L Tata, D Kendrick, T Burch, M Kennedy, E Orton

Burns Volume 42 Issue 7 , 2016

Objective To describe patterns in thermal injury incidence and hospitalisations by age, gender, calendar year and socioeconomic status among 0–4 year olds in England for the period 1998–2013. Participants 708,050 children with linked primary care and hospitalisation data from the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES), respectively. Analysis Incidence rates of all thermal injuries (identified in CPRD and/or HES), hospitalised thermal injuries, and serious thermal injuries (hospitalised for ≥72 h). Adjusted incidence rate ratios (IRR) and 95% confidence intervals (95%CI), estimated using Poisson regression. Results Incidence rates of all thermal injuries, hospitalised thermal injuries, and serious thermal injuries were 59.5 per 10,000 person-years (95%CI 58.4–60.6), 11.3 (10.8–11.8) and 2.15 (1.95–2.37), respectively. Socioeconomic gradients, between the most and least deprived quintiles, were steepest for serious thermal injuries (IRR 3.17, 95%CI 2.53–3.96). Incidence of all thermal injuries (IRR 0.64, 95%CI 0.58–0.70) and serious thermal injuries (IRR 0.44, 95%CI 0.33–0.59) reduced between 1998/9 and 2012/13. Incidence rates of hospitalised thermal injuries did not significantly change over time. Conclusion Incidence of all thermal injuries and those hospitalised for ≥72 h reduced over time. Steep socioeconomic gradients support continued targeting of preventative interventions to those living in the most deprived areas.

Burn or scald injuries are injuries that cause damage to the skin from excessive heat.

Home safety equipment can include smoke and carbon monoxide alarms, cupboard locks, mixer taps, and fire guards.

Expert commentary

This elegant study addresses a topic too seldom researched: the incidence of home accidents in children. It is particularly important because home accidents are increasing and the highest incidence is at either end of life. The research is population based, over a period of 15 years.

The findings that serious injuries are most common in the 15-17 month age group, and that severity is highly linked with deprivation, is a call to arms for those working with vulnerable families. These children suffer multiple deprivation including the potentially avoidable pain of burns, and the trauma of admission to hospital. Admissions for childhood burns did not decline in the period, so there is an onus on those working for prevention to take home accidents seriously.

Professor Yvonne Doyle, Director for London, Public Health England

Categories

  •   Child Health, Public Health, Skin conditions, Acute and general medicine