Missed Opportunities for the Detection of Physical Abuse and Neglect among Patients Hospitalized with Burns at a Tertiary Children’s Hospital in Greece

Background: Existing data indicate that child physical abuse and neglect may be under-recognized and under-reported in Greece.

Objective: To determine possible missed opportunities in detecting physical abuse and neglect among children hospitalized for burns at a tertiary children’s hospital in Greece.

Methods: Children aged 0 – 6 years hospitalized from January 2014–December 2015 with a discharge diagnosis of burn were retrospectively identified from the hospital electronic discharge database. Based on paper records, two pediatricians reached a consensus rating on the likelihood of abuse on each case using a 7-point Clinical Abuse Scale with three levels of confidence for abuse (definite, likely, and questionable), an indeterminate middle rating and 3 levels of confidence for accident (definite, likely, and questionable). One subcategory in the categories of likely and questionable accident involved neglect. Any documentation of indicators of abuse or neglect in the records was noted.

Results: Of the 67 patients identified:

• The mean age was 1.8 years (3.5 months – 5.1 years).
• The researchers categorized 1 as definite abuse, 11 as questionable abuse, 13 as questionable accident, 33 as likely accident, and 9 as indeterminate cause.
• 23 out of 46 cases categorized as questionable and likely accident involved neglect.
• There was no documentation of indicators of abuse or neglect in the records reviewed.

Of the 12 patients categorized as abuse:

• The mean age was 1.9 years (5 months – 4.5 years).
• The single case categorized as definite abuse and 6 out of 11 cases categorized as questionable abuse were infants.

Conclusion: This review of 67 children hospitalized at a children’s hospital in Greece with burns suggests missed opportunities for the detection of child abuse and neglect.