Historical findings (7):
(1) burn attributed to a sibling
(2) the child brought for medical care by an unrelated adult
(3) differing historical accounts
(4) delay in treatment > 24 hours
(5) history of numerous previous accidental injuries
(6) inappropriate affect in the parent or lack of parental concern or distancing from child
(7) inappropriate affect in the child (passive, introverted, fearful, remote, unresponsive)
Physical findings (6):
(8) history incompatible with the physical examination
(9) burn incompatible with development age
(10) mirror image burns of the extremities
(11) localized burns of perineum, genitalia and/or buttocks
(12) burn older than history given
(13) other injuries present (hematomas, lacerations, fingernail marks, scars, old bone fractures)
where:
• In the original paper there were 7 physical findings, with old fractures found on skeletal X-rays as a separate finding.
total number of factors =
= SUM(number of findings present)
Interpretation:
• minimum number of factors: 0
• maximum number of factors: 13
• In the study by Hammond et al, the presence of 2 or more of the factors was associated with a > 60% probability of child abuse.
• The use of the checklist routinely can help increase detection of child abuse cases.
In the study by Clark et al, the following items were found to have p values > 0.05 (the other factors had values ranging from 0.00004 to 0.026):
(2) the child brought for medical care by an unrelated adult (p = 0.85)
(4) delay in treatment > 24 hours (p = 1.0)
(7) inappropriate affect in the child (p = 0.15)
(11) localized burns of perineum, genitalia and/or buttocks (p = 0.15)
(12) burn older than history given (p = 1.0)
