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Child maltreatment by non-accidental burns: interest of an algorithm of detection based on hospital discharge database

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Abstract

Objectives

To build a detection algorithm of non-accidental pediatric burns (NAB) using hospital resumes from the French Hospital Discharge Database (HDD) and to describe cases with no judicial or administrative report.

Materials and methods

Children aged 0–16 years old hospitalized at the University Hospital of Tours from 2012 to 2017 with a coded burn were included. “Probable” or “possible” HDD cases of NAB were defined based on the International Classification of Diseases 10th version codes during the inclusion stay or the previous year. A chart review was performed on all the HDD cases and HDD non cases matched on sex and age with a 1:2 ratio. Performance parameters were estimated for three clinical definitions of child maltreatment: excluding neglect, including neglect in a restrictive definition, and in a broad definition. For clinical cases, report to the judicial or administrative authorities was searched.

Results

Among the 253 included children, 83 “probable” cases and 153 non-cases were analyzed. Sensitivity varied from 48 (95%CI [36–60], excluding neglect) to 90% [55–100] and specificity from 70 [63;77] to 68% [61;74]. The proportion of clinical cases with no report without justification varied from 0 (excluding neglect) to > 85% (with the broadest definition); all corresponded to possible isolated neglect.

Conclusion

The performances of the algorithm varied tremendously according to the clinical definition of child maltreatment. Neglect is obviously complex and tough to clinically detect. Training for healthcare professionals and qualitative studies on obstacles to report should be added to this work.

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Acknowledgments

To Pr Pauline Saint-Martin, Department of legal medicine, University hospital of Tours, France, for her advice during the elaboration of the lists and the decision tree.

To Mrs Anne-Isabelle Lecuyer, Public Health and Epidemiology Unit, University Hospital of Tours, France, for her participation in the initiation of the study.

Funding

This research received a grant (“year for research” attributed to CH) from the Teaching hospital of Tours (Tours, France) for the year 2017–2018.

Author information

Authors and Affiliations

  1. Public Health and Epidemiology Unit, Teaching Hospital of Tours, 2 boulevard Tonnellé, 37044, Tours cedex 9, France

    Coralie Hermetet, Émeline Laurent, Christophe Gaborit, Mélanie Biotteau & Leslie Grammatico-Guillon

  2. Research Team “Education, Ethics and Health” (EA 7505), University of Tours, 2 boulevard Tonnellé, 37044, Tours cedex 9, France

    Coralie Hermetet & Émeline Laurent

  3. Medicolegal Unit, Teaching Hospital of Rennes, 2 rue Henri Le Guilloux, 35033, Rennes cedex 9, France

    Coralie Hermetet

  4. Department of Paediatrics, Hospital of Blois, Les Sept Arpents, 41260, Blois, France

    Yasmine El Allali

  5. Paediatric Emergency Department, Teaching Hospital of Tours, 49 boulevard Béranger, 37044, Tours cedex 9, France

    Annie Urvois-Grange

  6. University Psychiatric Clinic, Teaching Hospital of Tours, 12 rue du Coq, 37540, Saint-Cyr-sur-Loire, France

    Mélanie Biotteau

  7. Pediatric Burn Unit, Teaching Hospital of Tours, 49 boulevard Béranger, 37044, Tours cedex 9, France

    Anne Le Touze

  8. University of Tours, 60 rue du Plat d’Étain, 37020, Tours cedex 1, France

    Leslie Grammatico-Guillon

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  1. Coralie Hermetet
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  2. Émeline Laurent
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Contributions

Conceptualization: CH, EL, YEA, AUG, MB, and LGG; Data curation: CH and CG; Formal analysis: CH and CG; Investigation: CH and ALT; Methodology: CH, EL, and LGG; Project administration: EL and LGG; Software: CG; Supervision: CH, EL, and LGG; Validation: EL and ALT; Roles/writing—original draft: CH, EL, and LGG; Writing—review and editing: YEA, AUG, and ALT.

Corresponding author

Correspondence to Coralie Hermetet.

Ethics declarations

This study was approved by the French Comité d’expertise pour les recherches, les études et les évaluations dans le domaine de la santé CEREES (n° TPS 53083bis). This study was also performed in accordance with the French Reference Methodology procedure MR-004 for retrospective studies, elaborated by the French authority Commission Nationale de l’Informatique et des Libertés CNIL.

Conflict of interest

The authors declare that they have no conflict of interest.

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Hermetet, C., Laurent, É., El Allali, Y. et al. Child maltreatment by non-accidental burns: interest of an algorithm of detection based on hospital discharge database. Int J Legal Med 135, 509–519 (2021). https://doi.org/10.1007/s00414-020-02404-y

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