Flame time of a cigarette lighter to achieve temperature capable of inflicting a burn.

OBJECTIVE: Cigarette lighters are frequent vectors in intentional contact burns. Time and temperature needed to cause thermal injury are considered to differentiate accidental from inflicted burns. This study examines the minimum time needed to heat a cigarette lighter's top to temperatures capable of inflicting any clinically visible skin burn. This information could be useful in child abuse and other forensic cases. METHODS: A literature search was performed to establish the time and temperature at which partial/full thickness skin burns are acquired, regardless of vector. Using a thermocouple, the temperature of the top of two common lighters was measured at ten second intervals while sustaining maximal flame held both upright and sideways and during cooling once the flame was extinguished. RESULTS: In the literature, the lowest temperatures documented to cause burns in one second were 69°C-70°C for transepidermal or partial thickness burns. From an ambient temperature prior to flame ignition, it took over 50s for the lighter tops to reach 60°C when held upright. After 180s, the lighters were shut off. It then took less than 60s for the lighters to cool to less than 60°C. The BIC lighter held to the side heated to 60°C in about 15s and needed over 100s to cool to under 60°C. CONCLUSIONS: Cigarette lighter burns are often blamed on non-intentional occurrences. At least 50s of sustained flame is needed to heat typical cigarette lighter tops to temperatures capable of inflicting clinically visible skin burns. This time is longer than the time required to light a cigarette. Therefore, for a cigarette lighter to inflict a contact burn injury, there needs to be intent and preparation, making accidental cigarette lighter burns unlikely.

Referral patterns and service utilization in a pediatric hospital-wide intimate partner violence program.

OBJECTIVES: To describe the referral patterns and utilization of on-site intimate partner violence (IPV) services in both inpatient and outpatient settings at a large urban children's hospital. METHODS: Retrospective review of case records from IPV victims referred to an on-site IPV counselor between September 2005 and February 2010. Descriptive statistics were used to examine IPV victim demographics, number of referrals per hospital department, referral source (type of staff member), time spent by IPV counselor for initial consultation, and services provided to IPV victims. RESULTS: A total of 453 unique referrals were made to the IPV counselor: 81% were identified by universal screening and 19% by risk-based screening. Thirty-six percent of IPV victims were referred from primary care clinics; 26% from inpatient units; 13% from outpatient subspecialty clinics; 12.5% from the emergency department; 5% from the Child Protection Program; and 4% were employee self-referrals. Social workers generated the most referrals (55%), followed by attending physicians (17%), residents (13%), nurses (7%), and other individuals (self-referrals) (4%). The median initial IPV intervention required 42 minutes. Supportive counseling and safety planning were the services most often utilized by IPV victims. CONCLUSIONS: IPV screening can be successfully integrated in both inpatient and outpatient settings by a multidisciplinary group of hospital staff. Most referrals were generated by universal screening outside of the primary care setting. IPV victims generally desired supportive counseling and safety planning over immediate housing relocation. Many IPV screening opportunities were missed by using verbal screening alone.

Results of a multifaceted Intimate Partner Violence training program for pediatric residents.

OBJECTIVE: To evaluate the efficacy of a multifaceted Intimate Partner Violence (IPV) intervention on knowledge, attitudes, and screening practices of pediatric residents. METHODS: The intervention included: an on-site IPV counselor, IPV training for attending physicians, residents and social workers, and screening prompts. Evaluation included baseline and post-training surveys of residents, assessing their knowledge, attitudes, and comfort with IPV screening, patient chart reviews at baseline, 3 months, and 8 months for documentation of IPV screening, and review of the IPV counselor's client charts. RESULTS: Baseline chart review showed screening rates of less than 1%. Screening rates were 36.2% at 3 months and 33.1% at 8 months. After training, residents were more likely to know: IPV screening questions (47.1% vs. 100%); referral sources (34.3% vs. 82.9%); and the relationship between child abuse and IPV (52.9% vs. 97.1%). At baseline, barriers to IPV screening included time (50%), lack of knowledge of how to screen (26.5%) and where to refer (23.5%). Post-training, barriers were time (44%), presence of children (25.9%) or other adults (18.5%) in the room, and inappropriate location (18.5%). Post-training, none of the residents listed "lack of knowledge" or "lack of referral sources" as barriers to IPV screening. After 12 months, 107 victims of IPV were identified; most referred from inpatient units and subspecialty clinics. CONCLUSION: A multifaceted IPV intervention increased identification of IPV victims and markedly improved attitudes, comfort, and IPV screening practices of pediatric residents. IPV screening rates were sustainable with minimal ongoing training. PRACTICE IMPLICATIONS: Consideration should be given to the training and practice supports necessary to encourage IPV screening in the pediatric setting. Educational efforts that familiarize pediatricians with the content surrounding the risk and potential impact of IPV to children and families along with practice supports that make incorporating screening for IPV as easy as possible have the potential to increase the identification of this problem and promote referrals to IPV agencies for follow-up and intervention where needed.