JBUR-4888; No.

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Available online at www.sciencedirect.com

ScienceDirect

journal homepage: www.elsevier.com/locate/burns

Spatial analysis of pediatric burns shows

geographical clustering of burns and ‘hotspots’
of risk factors in New South Wales, Australia

David Goltsman a,b,*, Zhe Li a,b, Eleanor Bruce d, Siobhan Connolly e,

John G. Harvey b,c, Peter Kennedy a,b, Peter K.M. Maitz a,b
a
Burns Unit, Concord Repatriation General Hospital, Concord, NSW, 2130, Australia
b
Sydney Medical School, The University of Sydney, NSW 2006, Australia
c
The Children’s Hospital Burns Research Institute, Burns Unit, The Children’s Hospital at Westmead,
Westmead, NSW, Australia
d
School of Geosciences, Madsen Building F09, University of Sydney, NSW 2006, Australia
e
New South Wales Agency for Clinical Innovation, Statewide Burn Injury Service, Australia

article info abstract

Article history: Objective: Pediatric burns are a significant cause of morbidity and mortality, and it is
Accepted 23 February 2016 estimated that more than 80% are preventable. Studies among adults have shown that
burns risk are geographically clustered, and higher in socioeconomically-disadvantaged
Keywords: areas. Few studies among children have examined whether burns are geographically
Pediatric burns clustered, and if burn prevention programs are best targeted to high-risk areas.
Trauma Method: Retrospective analyses examined the 2005-to-2014 NSW Severe Burns Injury Service
Burns prevention data. Geospatial imaging software was used to map the relative-risk and clustering of burns by
Health policy postcodes in Greater Sydney Area (GSA). Cluster analyses were conducted using Getis-Ord and
Plastic surgery Global Moran’s I statistics. High- and low-risk populations and areas were examined to
ascertain differences by sociodemographic characteristics, etiology and the extent of the burn.
Results: Scalds were the most common types of burns and boys were at greater risk than girls.
There was significant clustering of burns by postcode area, with a higher relative risk of burns
in western and north-western areas of Sydney. The high-risk clusters were associated with
socioeconomic disadvantage, and areas of low burns risk were associated with socioeconomic
advantage. In both high- and low-risk areas burns occurred more frequently in the 12–24
months and the 24–36 months age groups. The implication of this study is that pediatric burns
risk clustering occurs in specific geographic regions that are associated with socioeconomic
disadvantage. The results of this study provide greater insight into how pediatric populations
can be targeted when devising intervention strategies, and suggest that an area-targeted
approach in socioeconomically-disadvantaged areas may reduce burns risk.
# 2016 Elsevier Ltd and ISBI. All rights reserved.

* Corresponding author at: Burns Unit, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia.
Tel.: +61 2 9767 7775; fax: +61 2 9767 7435.
E-mail address: dgoltsman@optusnet.com.au (D. Goltsman).
http://dx.doi.org/10.1016/j.burns.2016.02.026
0305-4179/# 2016 Elsevier Ltd and ISBI. All rights reserved.

Please cite this article in press as: Goltsman D, et al. Spatial analysis of pediatric burns shows geographical clustering of burns and ‘hotspots’ of
risk factors in New South Wales, Australia. Burns (2016), http://dx.doi.org/10.1016/j.burns.2016.02.026
JBUR-4888; No. of Pages 9
2 burns xxx (2016) xxx–xxx
1. Introduction
Burns are a significant cause of morbidity and mortality
worldwide, and children are disproportionately affected. More
than half of the disability-adjusted life years lost to burns
occur among those aged 0–14 years [1]. Those with non-fatal
burns often experience substantial physical and psychological
morbidities [2], undergo surgical interventions and extended
periods of rehabilitation [2]. Therefore, pediatric burns impose
a high financial cost on the healthcare system, and a
significant personal burden to affected individuals.
Declines in burn-related deaths and hospitalizations have
been attributed, in part, to prevention strategies [3]. However,
these have been less effective among children from lower
socioeconomic backgrounds. Studies have estimated that
socioeconomic disadvantage is associated with a 3- and
15-fold greater likelihood of hospital admission or death from
burns, respectively [4,5].
Geographic information systems (GIS) permit the genera-
tion of maps that depict the geographic distribution of burn
injuries [6]. This has powerful implications for burn-preven-
tion strategies by enabling programs to be tailored according
to the demographic and socioeconomic characteristics of
residents [7]. Australian studies have shown that pediatric
burns are a major contributor to overall burns in high-risk
areas, and such areas are characterized by socioeconomic
disadvantage [7,8].
This study examines the geographical patterning of severe
burns among children in New South Wales (NSW), Australia
and investigates the spatial patterning of risk factors in
Sydney.
2. Methods
NSW is the most populous Australian state [11] (Fig. 1), with
Sydney the capital. Most of the population resides in
metropolitan regions (64%) [9]. There are three specialist
burns centers to which severe cases are transferred: Concord
Repatriation General Hospital (CRGH), Royal North Shore
Hospital (RNSH) and the Children’s Hospital at Westmead
(CHW).
2.1. Data
Data were obtained from the New South Wales Agency for
Clinical Innovation Statewide Burns Injury Service (SBIS)
covering 2005–2014. This is a statewide registry of burns
admitted to the burn units. Admission is based on criteria
established by the Australian and New Zealand Burns
Association (ANZBA), and the International Society for Burn
Injuries (ISBI). This includes all full/dermal-thickness burns in
children with >5% total burn surface area (TBSA), burns to the
face, hands, feet, genitalia, perineum and across major joints,
chemical, electrical or inhalation burns, circumferential burns
of the limbs or chest, burns in patients with pre-existing
medical disorders that could adversely affect patient care and
outcomes, suspected non-accidental injuries. The SBIS de-
tailed 8,223 pediatric burns in the period. The following data
Please cite this article in press as: Goltsman D, et al. Spatial analysis of pediatric burns shows geographical clustering of burns and ‘hotspots’ of
risk factors in New South Wales, Australia. Burns (2016), http://dx.doi.org/10.1016/j.burns.2016.02.026
were available for each case: patient demographics, mecha-
nism of burn, extent of burn and adequacy of first aid.
2.2. Analyses
Similar to a previous study, the analyses took place in several
stages [7]. Firstly, the relative risks of severe pediatric burns
were calculated for each postcode. The binary outcome
variable was experiencing or not experiencing a burn.
Population data from the 2011 ABS Census data were used
as the reference population for each area [11].
For subsequent analyses, only postcodes pertaining to
Sydney and the greater Sydney area were included in the
current study due to the low prevalence of burns and low
population density outside of this area. These were identified
by the Greater Capital City Statistical Area (GCCSA), as defined
by the Australian Bureau of Statistics (ABS, 2011) [11].
Secondly, the spatial distribution of relative risks of severe
pediatric burns was examined using the Getis-Ord statistic
[13]. The Getis-Ord test examines the spatial patterning of risk
in the areas surrounding each postcode, as it assesses the
extent to which each area is surrounded by areas of high or low
risk [12], therefore it facilitates the detection of ‘‘pockets’’ of
spatial association [13]. Positive values (positive z-scores) are
indicative of a statistically-significant clustering of high risk,
whereas negative values denote a statistically-significant
clustering of low risk. A value approaching zero is suggestive
of no clustering.
In the third stage of analyses, the abovementioned spatial
relative risk and cluster analyses were used to examine the
epidemiological and sociodemographic characteristics of the
residents of high- and low-risk areas. The Getis-Ord analyses
identified ‘‘pockets’’ of spatial association based on postal
relative risk values as the weighted reference points. These
Getis-Ord z-score values were used to define two populations:
a high-risk population and a low-risk population. The Getis-
Ord methodology produced an unbiased, natural distribution
of the relative risk of burns in NSW [14], and the two sub-
populations were defined as being the two extreme ends of the
distribution. The tails considered for this study pertained to
the 99% confidence interval, thus having a significance level of
p = 0.01, and the Getis-ord z-score of 2.58. Low-risk areas were
defined as a score < 2.58 or and the high-risk areas having a
score >2.58. These two populations were then contrasted
using descriptive statistics to observe differences in age
patterns by gender, etiology, extent of burn, adequacy of first
aid and sociodemographic variations using Microsoft excel
and R-statistical software.
The ABS Socio-economic Indexes for Areas (SEIFA) [10]
were used to examine associations with area-level socioeco-
nomic characteristics [10]. This is a composite index that
characterizes areas with regard to their education, occupation
and income [10]. Associations between spatial clusters of
relative risk of pediatric burns, the SEIFA index and four sub-
indices derived from the SEIFA index (i.e. Index of Relative
Socio-economic Disadvantage, Index of Economic Resources
and Index of Education and Occupation (ABS 2011) were
examined using scatter plots. Chloropleth maps were also
generated for three SEIFA variables: Index of Relative Socio-
economic Disadvantage, Index of Economic Resources and
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burns xxx (2016) xxx–xxx
Fig. 1 – Location map of New South Wales and the Greater Sydney Area.
Index of Education and Occupation. The indices were divided
into deciles, to improve map comparison accuracy.
3. Results
3.1. Spatial distribution of burns
The map of burns risk by area in The Greater Sydney Area is
shown in Fig. 2 Higher risk was seen in the western and north
western areas of Sydney corresponding with the ‘disadvan-
tage places’ identified by the Australian Housing and Urban
Research Institute (AHURI) [44]. The spatial autocorrelation
Fig. 2 – Map depicting the relative risk of severe pediatric
burns in regional NSW and the Greater Sydney Area.
Please cite this article in press as: Goltsman D, et al. Spatial analysis of pediatric burns shows geographical clustering of burns and ‘hotspots’ of
risk factors in New South Wales, Australia. Burns (2016), http://dx.doi.org/10.1016/j.burns.2016.02.026
3
analyses showed a significant Global Moran I statistic
( p = 0.05), confirming spatial clustering of burns among
children in the greater Sydney area.
AHURI also identified socio-demographically typologies
within these ‘disadvantaged places’. The 2 typology categories
that occur in the western and north western ‘hot spots’ are
typology category 1 (high on young people and single parent
house holds) and typology category 2 (high on overseas
movers and two parent families).
In the greater Sydney area, spatial clustering of high risk
was evident in the western and north-western areas (Fig. 3),
and two clusters of low risk were seen in the eastern and
south-eastern areas. The high-risk clusters were associated
with socioeconomic disadvantage, and one of the areas of low
burns risk was associated with socioeconomic advantage
(Fig. 4).
3.2. Demographic characteristics
Of the 8223 pediatric burns 2523 (30.68%) of the children
resided in high-risk areas and 457 (5.56%) resided in low-risk
areas. The mean age in high-risk areas was 3.91 years (SD 3.94),
and 4.18 (SD 4.31) in low-risk areas. The age distribution of
burns in high- and low-risk areas is shown in Fig. 5. Burns were
most frequent in the 13–24 month age group.
Across all age groups the majority of burns occurred among
boys (58%). However, there was a higher proportion of girls
with burns in the 3–5 and 6–10 years age groups (3.08% and
2.26% higher, respectively). In high-risk areas there was a
significant male dominance in the 13-24 month and 11–15
years age groups, with a difference of 2.53% and 2.08%
between males and females. In low-risk areas there was a
significant male dominance in the 25–36 months and 13–24
months age groups, with a difference of 5.46% and 3.46%
between males and females. There was a significant female
dominance in the 3–5 years and 6–10 years age groups with a
difference of 3.08% and 2.26% between females and males.
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4 burns xxx (2016) xxx–xxx

Fig. 5 – Graph of the age distribution of burns (by

Fig. 3 – Map depicting the Getis-Ord analysis of Pediatric frequencies) for high and low risk areas.
burns in the Greater Sydney Area. High Getis-Ord z-scores
indicate more intense clustering of pediatric burn
frequencies (hotspots or positive clusters), shown in red,
and low z-scores indicate more intense clustering of low
pediatric burn frequencies, shown in blue (cold spots or
negative clusters). (For interpretation of the references to
color in this figure legend, the reader is referred to the web
version of the article.)

Fig. 6 – Graph of the etiology of burns (by frequency) in high

and low risk areas.
Fig. 4 – Map depicting the index of relative socio-economic
disadvantage.

(2.66% difference) burns compared to low-risk areas. In low-

3.3. Burn etiology
The etiology of burns were analyzed in terms of postal areas
and %TBSA (Fig. 6). In high-risk areas there was a significantly
higher proportion of scald (2.69% difference) and friction
risk areas there was a significantly higher incidence of contact
(5.25% difference) and flame (1.07% difference) burns.
Compared to low-risk areas, high-risk areas showed the
following risks: 11 times the risk of friction burns, 10 times the
risk of radiant heat burns, 8 times the risk of chemical burns, 7
times the risk of burns resulting from explosions, 6 times the

Please cite this article in press as: Goltsman D, et al. Spatial analysis of pediatric burns shows geographical clustering of burns and ‘hotspots’ of
risk factors in New South Wales, Australia. Burns (2016), http://dx.doi.org/10.1016/j.burns.2016.02.026
JBUR-4888; No. of Pages 9

burns xxx (2016) xxx–xxx 5

risk of scald burns, 5 times the risk of contact burns, and 4
times the risk of flame burns compared to low-risk areas.
The etiology of burns differed between boys and girls,
however the gender patterning of burns did not vary between
high-and low-risk areas (Fig. 7).
In high-risk areas, burns involving less than or equal to
10% TBSA were mainly due to scalds (61.15%), contact
(26.20%) and friction (5.64%) burns. Burns in high-risk areas
that accounted for 10% or more TBSA were mainly due to
scalds (78.95%), flames (14.04%) or radiant heat (7.02%). A
similar pattern was seen in low-risk areas, with burns 10%
TBSA being due to scald (58.69%), contact (31.83%) and flame
(4.06%) burns. In low-risk areas burns over 10% of TBSA
were mainly due to scalds (64.29%) and flames (35.71%).
(Fig. 8)
3.4. Adequacy of first aid
The adequacy of burn first aid was assessed on the basis of
clinical history provided by patients on admission to hospital.
Using ISBI and NSW SBIS guidelines adequate first aid was
considered to be cooling the burn surface by the application of
running cold water.
In high-risk areas fewer burns received adequate first-aid
(57.27%) compared to low-risk areas (64.77%). One death due to
burns occurred over the study period.

Fig. 7 – Table showing the mechanisms of pediatric burns for high and low risk areas according to gender.

Fig. 8 – Table showing the mechanisms of pediatric burns for high and low risk areas according to extent of injury (%TBSA).

Please cite this article in press as: Goltsman D, et al. Spatial analysis of pediatric burns shows geographical clustering of burns and ‘hotspots’ of
risk factors in New South Wales, Australia. Burns (2016), http://dx.doi.org/10.1016/j.burns.2016.02.026
JBUR-4888; No. of Pages 9

6 burns xxx (2016) xxx–xxx

3.5. Socioeconomic characteristics of areas
Fig. 9a shows spatial clusters of low risk in socio-economical-
ly-advantaged areas, as captured by the composite SEIFA
index, corresponding with postcodes in the Sydney area. The
scatterplots shown in Fig. 9b illustrates no association
between burns risk and access to economic resources (ABS,
2013). However, burns risk increased with lower levels of
education and occupation (Fig. 9c).
4. Discussion
This study used geospatial analyses to examine clustering of
pediatric burns in the greater Sydney area. The findings
showed significant clusters of high- and low risk in Sydney.
Furthermore, this study extended previous knowledge of
pediatric burns by utilizing a novel spatial analytical method
to identify areas of increased/decreased risk and their
association with sociodemographic factors, burn etiology
and adequacy of first aid. Overall, the findings support that
an area-based approach targeting lower socioeconomic areas
may be effective for the prevention of pediatric burns in NSW
and Sydney.
The findings of the current study concur with similar
research that was conducted in the Sydney area. Goltsman
et al. [7] applied similar geospatial methods to assess burns in all
age groups and found similar associations as seen in this
pediatric population. Poulos et al. [8] applied geospatial analyses
on pediatric burns in NSW from 2000 to 2005 and also found a
greater relative risk of pediatric burns in the western Sydney
area. A key difference between Poulos et al. and the current
study is that Poulos et al. used local government areas (LGAs)
rather than postcodes as spatial units of analysis. The use of
LGAs may limit an examination of associations between
relative burn rates and area-level sociodemographic factors,

Fig. 9 – Scatter plots showing association between the statistic (Gi*) indicating level of local spatial clustering and (a) index of
relative socio-economic disadvantage, (b) index of economic resources and (c) index of education and occupation. Red
indicates postcodes within statistically significant positive clusters (higher relative risk of pediatric burns), blue indicates
postcodes within negative clusters (lower relative risk of pediatric burns) and yellow indicates postcodes which are not
significantly clustered. (For interpretation of the references to color in this figure legend, the reader is referred to the web
version of the article.)

Please cite this article in press as: Goltsman D, et al. Spatial analysis of pediatric burns shows geographical clustering of burns and ‘hotspots’ of
risk factors in New South Wales, Australia. Burns (2016), http://dx.doi.org/10.1016/j.burns.2016.02.026
JBUR-4888; No. of Pages 9
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due to local level variability within these larger areas. LGAs
encompass several postcodes and their use as spatial units in
analysis tends to lead to a ‘dilution’ of associations within area-
level sociodemographic characteristics. The current study
represents a significant addition on previous Australian
research by using postcode areas, thereby enabling a more
detailed and nuanced examination of area-level socioeconomic
characteristics on pediatric burns risk in Australia than has
been achieved previously. The geospatial methodology used
provides a unique platform for in-depth social ecological
exploration to understanding the determinants of burns.
Differences in the incidence and nature of burns were evident
by area-level socioeconomic characteristics. The results of this
study showed a significant association between high-risk burns
areas and areas associated with the 30th percentile of most
socioeconomically disadvantaged communities in Australia.
International studies in developing and industrialized countries
have identified risk factors for burns in the community, also
finding that high population density, low literacy, ethnic
minorities and income deprivation are associated with greater
burns risk [15,45]. Furthermore, risk is increased in single-
parent families and among people residing in sub-optimal living
environments (i.e. crowded housing and lack of running
water) [16].
Although a strength of the study, the use of postcode as
the spatial unit to characterize area-level socioeconomic
conditions was also a limitation. SEIFA scores for larger
geographies, such as postcodes, are derived from the
population weighted average of smaller unit scores which
may mask socio-economic diversity within an area. Use of
postcode level SEIFA information as a proxy for socio-
economic disadvantage of individuals is susceptible to
ecological inference fallacy particularly if there is individual
diversity within the area. Although limitations of postcode
level data need to be recognized in examining association
between pediatric burn incident and socio-economic disad-
vantage, SEIFA is a robust data source that has potential for
informing the targeting of broader scale community aware-
ness initiatives.
Worldwide, children are commonly the victims of serious
burn injuries and often suffer pain, deformity, disability,
and occasionally death [17]. The higher incidence has been
attributed to common characteristics associated with
children at this age: impulsiveness, lack of awareness, high
energy levels, natural curiosity and total dependence on
their caregiver [18–22]. In their thorough review of global
burns Rayner and Prentice found that globally children
under the age of 2 years had the highest risk of DALYS lost
due to burns with the highest incidence occurring in
children aged 7–12 months [23]. Mechanisms such as scalds
in this age group were attributed to care givers since infants
were unable to walk [24], in contrast older children had a
greater incidence of flame burns due to their age-related
characteristics [24,25]. Our study concurs with theses
finding of there being a significantly greater proportion of
scald burns occurring in children aged 12–36 months, and a
higher proportion of flame burns were seen in young
adolescents aged 11–15 years in both high- and low-risk
areas of Sydney. This result was similar to the findings of an
Australian study by Henderson et al. which identified that
Please cite this article in press as: Goltsman D, et al. Spatial analysis of pediatric burns shows geographical clustering of burns and ‘hotspots’ of
risk factors in New South Wales, Australia. Burns (2016), http://dx.doi.org/10.1016/j.burns.2016.02.026
7
95% of flammable liquid burns occurred in young adolescent
males [26].
The results of our study concur with those seen in multiple
studies, which assess developmental stages in children, and
the mechanisms of burn injuries. The majority of burns in
children aged 0–36 months were from scalds. A detailed
assessment by the National SAFE KIDS Campaign [27] in the US
had similar findings with scald burns accounting for the
majority of burns in this age group yet, they had further
identified that given the curiosity encountered at this age,
these injuries occurred mostly from hot liquids being spilled in
the kitchen or dining room. Agran et al. assessed 23,173
pediatric injuries by 3 monthly age intervals considering
pediatric stages of development. The study further identified
that for children aged 12–17 months the leading cause for
injuries were hot liquid and vapor injuries [28]. This age
coincides with the child satisfying their growing curiosity by
physically interacting with their surroundings. With the
attainment of milestones such as independent mobility and
exploratory behavior they are able to better pursue interesting
objects, noises and cues. As a result of these characteristics
and a child’s primitively developed hazard awareness and
avoidance skills [23,25], they are at high risk of accidents.
Given the lag between a child’s cognitive development and
advances in their motor skills, children may lack the ability to
escape dangerous situations and comprehend the ramifica-
tions of their actions.
While some burns can be life threatening to children, the
majority leave them with characteristics similar to chronic
illness due to serious long-term physical and psychosocial
problems [29]. Studies by have suggested that 20–50% of
children experience psychological maladjustment issues
showing symptoms such as depression, anxiety and a fear
of interacting with others after a severe burn [30]. Several
studies have shown that the most problematic of the
depressive reactions include suicidal ideations, self-rejec-
tion, aggressiveness, and irritability [31–36]. Anxiety is a more
common complaint among pediatric burn patients compared
to depression [36,37]. The most prevalent complaint of
patients with anxiety meets the DSM criteria for posttrau-
matic stress disorder [34,37]. PTSD and symptoms of PTSD
have been observed as being prevalent in burns survivors of
all ages [37,38].
The leading cause of pediatric burns is scalds [23,25], which
are avoidable in most instances. Studies in the US by Kemp
et al. have shown that 1-years old children are 10 times more
likely to sustain burns or scalds than any other year school-
aged child [39,40]. The incidence of scald burns drops
dramatically at 3 years of age, this is thought to be the
consequence of increased cognitive awareness of the dangers
of heat, coupled with more cautiousness and anticipatory
management by parents and a greater time spent out of the
home [40].
There is significant evidence from our study and other
studies to suggest that pediatric burns are associated with
socioeconomic disadvantage [5,7,8,23,25,40]. Various issues
and parental factors have been shown to play a significant role
in children suffering burns. These include factors such as:
income, parental knowledge of burn prevention and care,
education, literacy, parental age, supervision, home crowding,
JBUR-4888; No. of Pages 9
8 burns xxx (2016) xxx–xxx
installation of smoke alarm, adequate first aid, and features of
the home. Furthermore studies in Australia have also shown
that surrounding environment and socioeconomic factors
[7,8] are associated with risk of burns. Housing design, lack of
play area and child dependency has also been shown to
impact burns [41]. Many of these risk factors are modifiable
and preventable with appropriate interventions within the
community [42,43]. This study also highlights the issue of
higher risk areas for burns having greater rates of inadequate
first aid management for the injury. A study by this burns
center has also shown that there is also a systemic tendency
for overestimation to occur throughout the entire TBSA
spectrum, which is persists with increasing time after the
burn [46]. These findings infer that appropriate first aid with
timely presentation to a burns center would provide optimal
treatment and should be the central message for burns
prevention.
Successful prevention is a multi-factorial process that
incorporates environmental modifications, education, and
appropriate monitoring. Especially in the context of pediatric
burns, heightened awareness and behavioral changes are of
interest for caregivers to insure a decrease in the incidence of
such injuries. Evidence has arisen of the positive impact that
intensive interventions such as public health messages, and
local medical services providing brief education on burn
prevention. Gaffney et al. and Mehta et al. have shown that
such intervention can successfully reduce scald burn injuries
in children. Future research needs to examine the physical,
housing and psychosocial factors in these areas predisposing
to this greater risk. Interventions are then indicated to address
these factors if overall morbidity, mortality and inequalities in
burns are to be reduced.
5. Conclusion
Geospatial analytic methods can improve our understanding
of burns epidemiology. The results of this study showed that
burns risk clustered in specific regions. There was an
increased risk of pediatric burns in some socioeconomically
disadvantaged urban areas, and that residents of these areas
were less likely to apply adequate first aid. The results of this
study provide greater insight into how pediatric populations
can be targeted when devising intervention strategies.
Targeted strategies for high-risk pediatric populations may
optimize the effect of such interventions.
Conflict of interest
None.
Acknowledgments
We would like to thank the work of Anne Darton for her
assistance in collecting the data used in this analysis. We would
like to acknowledge the Julian Burton Burns Trust and Clipsal by
Schneider Electric for financially supporting the computer
hardware and software required to complete this study.
Please cite this article in press as: Goltsman D, et al. Spatial analysis of pediatric burns shows geographical clustering of burns and ‘hotspots’ of
risk factors in New South Wales, Australia. Burns (2016), http://dx.doi.org/10.1016/j.burns.2016.02.026
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