Every year in the UK an estimated 40,000 children are seen in emergency departments with burns and scalds, 4,000 of whom are admitted to burns and plastics units for treatment¹. 70% of burns and scalds are seen in children less than three years of age. Most happen in the home.The most common causes of scalds are hot drinks, or contact burns from household items such as irons, hair straighteners, radiators and oven doors that are in easy reach of the child.Whilst the majority of injuries are unintentional, up to10% are the result of neglect or physical abuse.Collecting anonymous information about children attending hospital with burns and scalds allows us to identify patterns of injuries to children.This helps us to:

• Understand how patterns in children’s burns change over time
• Develop and test interventions to prevent burns and scalds in children

Current research

Burns and Scalds Assessment Template (BaSAT)

The BaSAT is a standardised evidence-based burns and scalds clinical assessment template, designed for the emergency department. The contents were derived from a large scale epidemiology study that identified the characteristics of children who had sustained accidental burns and scalds and those who sustained burns from neglect or child abuse².The BaSAT is established in emergency departments and children's burns units in Cardiff, Swansea, North Wales, Bristol, Manchester and Denver Colorado, soon to be introduced in Birmingham. Data collected will inform prospective epidemiological studies of childhood burns and scalds and is being used to develop a clinical prediction tool to aid the recognition of children at risk of child abuse or neglect.

This project is funded by The Scar Free Foundation and Health and Care Research Wales

Timing: August 2012 – on-going

For further information contact: Professor Alison Kemp

Development of a Clinical Prediction Tool

Data collected from 800 burn and scald cases in the UK and 150 cases in the US have contributed to the development and validation of a clinical prediction tool (CPT). The BuRN-Tool applies a simple score to clinical features that identify children at risk of child abuse or neglect. This will enable clinicians to work with these families to reduce the risks to their children. We have conducted a qualitative study and shown that the BuRN-Tool has good acceptability and utility in clinical practice. The BuRN-Tool is now being evaluated in clinical practice in centres across the UK.

This project is funded by The Scar Free Foundation and Health and Care Research Wales

Timing: August 2012 – on-going

For further information contact: Professor Alison Kemp

Preventing burns and scalds in children (Primary Prevention)

Preschool children are at high risk from scalds from hot drinks. Working with professionals, parents and patients, we are currently developing and testing the feasibility of an intervention to reduce scalds from hot drinks in young children. The Safe Tea Campaign is being delivered by Health Visitors, Stay and Play groups and drop-in child care centres within Cardiff Flying Start. We are assessing the feasibility of introducing novel multimedia materials aimed at preventing hot beverage scalds to preschool children and improving burns first aid knowledge attitude and practice.

This project is funded by The Scar Free Foundation, Health and Care Research Wales, Avon Primary Care Research Collaborative Research Capability Funding and Cardiff City Exchange.

Timing: February 2015 – December 2016

For further information contact: Professor Alison Kemp or Dr Verity Bennett.

Health visitor intervention (Secondary Prevention)

Accident and emergency department (ED) attendances for children with burn and scald injuries are common, especially in young children. Children with one injury are more likely to have a further injury. Health visitors are informed of ED attendances for burns, and then assess the needs of these families but no resources are available to use at this sensitive time. We were awarded some funding to work with parents and health visitors to develop a framework of an intervention for health visitors to use with families whose children have had a burn/scald to prevent further injuries at home.  We are now exploring the possibility of taking this concept forward in collaboration with the Engineering Systems and Design group, University of Bristol, using photospheres.

Timing: Ongoing

For further information contact: Dr Toity Deave

Children's behaviour in dwelling fires

What would a child do if they found there was a fire in their home? We have completed three studies to help us begin to understand how children behave in a dwelling fire and how they make decisions. We completed a review of published evidence about children’s behaviour in fires at home, and worked with the Devon and Somerset Fire and Rescue Service to complete a feasibility study to find out if we can enable children to tell their story of being in a fire at home. This information could help fire personnel know where to search for children when they enter a burning building, and help the Fire and Rescue Service with their fire safety work in schools. We have also completed a survey of current fire safety education practice in the UK.

This project was funded by the University of the West of England, Bristol

Timing: August 2014 – January 2016

For further information contact: Dr Julie Mytton

Parents and carers views about preventing burns in young children

We have undertaken extensive patient and public involvement and have been collecting the views of parents and carers and Flying Start staff of infants and toddlers on how they think we can help parents prevent hot drink scalds in young children. Parents/carers have shared their thoughts and ideas including how best to use visual images, how radio advertising might be useful, and making QR codes available to gain more information. If you would like to get more information on future parent involvement sessions or would like to make a suggestion please get in touch.

This project is funded by The Scar Free Foundation

Timing: August 2012 – on-going

For further information contact: Diane Nuttall or Dr Verity Bennett

First Aid

Previous studies have shown us that parents of young children have low levels of knowledge and skills about how to give first aid for burns and scalds³. We are currently conducting two systematic reviews of the published literature on the effectiveness of community campaigns to improve first aid knowledge. We hope to identify what methods are most effective, and how best to evaluate first aid knowledge. These reviews will help to guide our own work to improve first aid knowledge in the community.

This project is funded by The Scar Free Foundation

Timing: August 2014 – on-going

For further information contact: Professor Alison Kemp

A little ExSTRA!

Collaboration with our colleagues from the US has enabled us to analyse data from the ExSTRA study, relating to 215 children with burns who were referred to Child Abuse Paediatricians in 20 US child abuse centres. These data enabled exploration of the injury characteristics of children with burns, in comparison with children assessed for possible abuse who presented with other injuries, and to investigate the epidemiology and characteristics of burns as a consequence of maltreatment, to determine the level of associated injuries amongst these children⁴.

This project was funded by The Scar Free Foundation and Health and Care Research Wales

Timing: June 2014 – February 2015

For further information contact: Professor Alison Kemp

Current PhD studies with the Prevention team

Primary prevention of burns and scalds "Toddler-Safe"

The Toddler-Safe programme is a randomised control trial of a DVD aimed at improving burns injury prevention knowledge and behaviour and improving burns first aid knowledge amongst parents/carers of preschool children in Cardiff. A randomised control trial amongst 312 parents/carers of preschool children has shown that parents who received a DVD training pack soon after child-birth demonstrated improved burns prevention knowledge and behaviour, with greater effects in parents from higher socio-economic groups. A systematic review of parent interventions for injury prevention in preschool children showed that parent interventions with educational and home-visiting components were effective.

This project is funded by Health and Care Research Wales

Timing: Anticipated completion December 2016

For further information contact: Professor Alison Kemp

School based burns prevention

School-aged children most commonly burn/scald themselves whilst preparing food and hot drinks in the home. Local fire and rescue services run educational programs in schools to prevent risk behaviours and domestic fires, but do not address injuries. This study has developed and is evaluating a school based burns prevention programme and improve knowledge and practice of appropriate first aid if they are injured. Harriet our PhD student has delivered the intervention in six schools across Cardiff and is evaluating the feasibility of rolling the programme out more widely.

This project is funded by Health and Care Research Wales

Timing: October 2014 – September 2017

For further information contact: Harriet Quinn-Scoggins

Epidemiology of burns and scalds in children and young people

The epidemiology of burns and scalds in children and young people is being explored through data collected via Hospital admission statistics (HES) and the Burns and Scalds Assessment Template – BaSAT. PhD student Moses is investigating inequalities associated with burn injuries to children and young people.

This project is funded by The Scar Free Foundation

Timing: December 2014 to November 2017

For further information contact: Moses Ikpeme

Student Projects

Undergraduate medical students from Cardiff University regularly join the research team for Special Study Components or Intercalated degrees.

Emma Johnson has completed a study on the epidemiology of non-scald burns which she has submitted for publication.

Lucy Hoskins studied the epidemiology of burns in schoolage children

Emma and Katie Davies are producing a paper on the health care burden of childhood burns using the BaSAT epidemiology database and national routine datasets.

References

1 Personal communication with National Burns Injury Database (http://www.ibidb.org/); UK accident statistics, Home and Leisure Accident Surveillance System (http://www.hassandlass.org.uk/reports/2002data.pdf); Secondary UK accident statistics, Home and Leisure Accident Surveillance System (http://www.hassandlass.org.uk/reports/2002data.pdf) 2002

2 Kemp A, Jones S, Lawson Z, Maguire S. Patterns of burns and scalds in children. Arch Dis Child. 2014 Apr;99(4):316-21. DOI:10.1136/archdischild-2013-304991

3 Davies M, Maguire S, Okolie C, Watkins W, Kemp A. How much do parents know about first aid for burns? Burns. 2013 Sep;39(6):1083-90. DOI: 10.1016/j.burns.2012.12.015

4. Pawlik, M., Kemp, A., Maguire, S., Nuttall, D., Feldman, K. and Lindberg, D., Children with burns referred for child abuse evaluation: Burn characteristics and co-existent injuries. Child Abuse & Neglect, 2016;55:.52-61. doi:10.1016/j.chiabu.2016.03.006