Specific patterns of inflicted burn injuries.

By retrospective review of 1,061 charts and prospective analysis of all accidental injuries seen in a Pediatric Emergency Room over a 5-year period, criteria were developed to identify the source of an injury as either specific or nonspecific, i.e., whether a unique causative mechanism was clear or not from the clinical or radiologic signs. These criteria were then used to diagnose 712 cases of child abuse, of which 43 were burns. There were four specific burn patterns. Readily evident were contacts with hot objects; the other were caused by various applications of hot liquids. In these latter cases, the position of the body at the time of burning could be precisely detected by analysis of the depth, configuration, distribution of the burns, and the reciprocal relation to flexion creases and joints of the spared areas. This information is a powerful tool for assessing the veracity of the history presented by the child's caretaker when considering a diagnosis of child battery.