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Utility of hair toxicology in detecting child abuse or neglect in the burn unit: A quality improvement project
Journal article   Open access   Peer reviewed

Utility of hair toxicology in detecting child abuse or neglect in the burn unit: A quality improvement project

Shady Al Hayek, Jack Bullis, Tessa A Davis-Walz and Colette Galet
Journal of burn care & research
05/08/2026
DOI: 10.1093/jbcr/irag071
PMID: 42102149
Appears in  UI Libraries Support Open Access
url
https://doi.org/10.1093/jbcr/irag071View
Published (Version of record) Open Access

Abstract

Children represent 20% of all burn admissions annually; 20-30% are related to abuse or neglect. Our institution Child Protective Services (CPS) recently decided to stop following and interpreting hair toxicology results for pediatric burn patients. Drug use/exposure is an important risk factor for child abuse/neglect. The goal of this study was to evaluate the value of hair toxicology testing to identify child abuse or neglect. Medical records of pediatric patients ≤14 years admitted between 1/1/2019 and 2/29/2024 were reviewed. Demographics, burn injury information, suspicion of child abuse/neglect on admission, routine urine drug screening tests, hair toxicology results, and reporting to the State Health and Human Services (HHS) were collected. Descriptive statistics were obtained. Univariate analyses were performed to assess the utility of hair toxicology with p < 0.05 considered significant. Two hundred ninety-eight patients were included; child abuse was suspected in 31.5%; hair toxicology performed for 75.2% and positive for 35.7%. Hair toxicology was more likely to be performed when child abuse was suspected on admission (81.9% vs. 72.1%, p = 0.044), and to be positive (40.4% vs. 20.6%, p < 0.001). Suspicion on admission was associated with higher HHS involvement (95.7% vs. 24%, p < 0.001). HHS was more likely to be involved when hair toxicology was performed (54% vs. 24.3%, p < 0.004) and positive (96.3% vs. 28.4%, p < 0.001). Hair toxicology screening for pediatric burn patients is still a valuable tool to help clinicians report suspected abuse/neglect not otherwise detected on admission using other tools.
 hair toxicology Children burn injury abuse/neglect UIOWA OA Agreement

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