Intentional scald must be excluded |
Intentional scald should be considered |
Intentional scald unlikely |
Mechanism – Immersion |
Pattern– uniform scald depth; skin fold sparing; central sparing buttocks (doughnut) |
Mechanism – spill injury; flowing water injury |
Agent – Hot tap water |
Distribution – glove and stocking; 1 limb glove/stocking |
Agent – non-tap water (beverage) |
Pattern – clear upper limits; scald symmetry (extremi-ties) |
Clinical Features – previous burn injury; neglect/faltering growth; history inconsistent with assessed development |
Pattern – irregular margin and depth; lack stocking distribution |
Distribution – isolated buttock/perineum, +/- lower extremities; isolated lower extremities |
Historical/Social features – trigger, such as soiling/enuresis/misbehavior; differing historical accounts; lack of parental concern; unrelated adult presenting child; child known to social services |
Distribution – asymmetric involvement lower limbs; head, neck and trunk or face and upper body |
Clinical Features – Associated unrelated injury; history incompatible with examination findings |
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Historical/Social features – Passive, introverted, fearful child; previous abuse; domestic violence; numerous prior accidental injuries; sibling blamed for injury |
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