The epidemiology of intentional burns

Exploring misclassification of injury intent: A burn register study

INTRODUCTION

Burn registers are an important source of surveillance data on injury intent. These data are considered essential to inform prevention activities. In South Asia, intentional burn injuries are thought to disproportionately affect women. Assessment of injury intent is difficult because it is influenced by personal, family, social, and legal sensitivities. This can introduce misclassification into data, and bias analyses. We conducted a descriptive, hypothesis generating study to explore misclassification of injury intent using data from a newly digitised single centre burn register in south India.

METHODS

Data from 1st February 2016 to 28th February 2022 were analysed. All patients in the data set were included in the study (n = 1930). Demographic and clinical characteristics for patients are described for each classification of injury intent. All data cleaning and analyses were completed using RStudio.

RESULTS

Injury intent data were missing for 12.6% of cases. It was the most commonly missing variable in the data set. "Accidental" injuries had a similar distribution over time, age, and total body surface area (TBSA) for males and females. "Homicidal" injuries were more common in females. Injuries reported as "Suicidal" affected men and women equally. A decrease in reporting of "Suicidal" injuries in females corresponded to an increase in high TBSA injuries classified as 'Other' or with missing data. Overwriting of injury intent was present in 1.5% of cases. The overwritten group had a greater proportion of females (62.1% vs. 48.5%) and higher median TBSA (77.5% vs. 27.5%) compared to the group where intent was not overwritten.

CONCLUSION

Our findings indicate that some subgroups, such as females with high TBSA burns, appear to be more likely to be misclassified and should be the focus of future research. They also highlight that quality of surveillance data could be improved by recording of clinical impression, change in patient reported intent, and use of a common data element for intent to standardise data collection. We also recommend that injury intent is recorded as a unique variable and should not be mixed with other elements of injury causation (e.g. mechanism). Although this is a single centre study, the methods will be of interest to those who utilise routinely collected data and wish to reduce misclassification of this important variable.

Self-inflicted burns in Brazil: systematic review and meta-analysis

INTRODUCTION

burns represent a pivotal component of trauma in Brazil, accounting for 2 million incidents and 2,500 deaths annually. Self-intentional burns are associated with a worse prognosis, larger burned surface area, higher infection rates, and death. The lack of studies on the issue of self-immolation raises epidemiological questions regarding Brazilian victims. This study aimed to investigate the profile of burn events associated with self-injurious behavior among Brazilian victims.

METHODS

this systematic review was performed according to PRISMA 2020 guidelines and evaluated the correlation between self-injurious behavior as a cause of burns in Brazilian victims and its epidemiological implications in the last 20 years (2003-2023). The MeSH terms "Burns", "Self-Injurious Behavior", "Epidemiology" and "Brazil" were queried in the PubMed/MEDLINE, SciELO, and Cochrane Library databases, and, after selection by inclusion/exclusion criteria, the most relevant studies were critically analyzed.

RESULTS

From 1,077 pre-selected studies, 92 were potentially eligible, resulting in 7 manuscripts incorporated in this review. From 3,510 burned victims assembled in the pool of selected studies, 311 cases displayed self-injurious behavior. Burned patients who attempted to burn their lives have a higher risk of death (p<0.05; RR=5.1 [3.2-8.1]) and larger burned surface area (p<0.05; MD=19.2 [10-28.2]), compared to accidental cases. Moreover, the female gender was at a higher risk of attempting self-immolation (p<0.05; RR=4.01 [2.9-5.5]).

CONCLUSION

our results show that self-inflicted burn cases were associated with a larger burned surface area and a higher risk of death, and the female gender was identified as a relevant risk factor in Brazil.

Social and psychological profile of pattern of female burn casualties

Background

Thermal injuries are one of the commonest causes of unnatural deaths in females in developing countries. However, there is a lack of adequate research into the social and psychological aspects that lead to such deaths. The suicidal death due to immolation by fire is a scourge on Indian society that is not being adequately addressed in all its aspects. There is an attempt in this study to bring awareness of the population under risk and to motivate prevention measures.

A retrospective cross-sectional study was conducted at the Victoria Hospital Mortuary for a period of 12 months between 2017 and 2018. Medicolegal and psychological autopsies were performed on 120 female burn victims over 15 years of age. The information gathered via medical records, police investigations, interviews with family, and postmortem findings was analyzed and compiled to obtain the following results.

Results

Most of the victims, i.e., 52% of the women, were illiterate. More than half of the victims, i.e., 53% of the women in this study, were found to be in the upper-lower socio-economic. Majority of the female victims (63.3%) were married for more than 7 years. Suicide was the commonest manner of death (52%). There was no alleged history of domestic abuse in most cases (73.3%). Only 2 cases, i.e., 1.7% of cases, were booked under Dowry Prohibition Act. Only 28.3% of cases were investigated by Magistrate’s Inquest. History of mental illnesses was reported only in 14.2% of victims. Alcohol was detected in only 2 of the victims (1.7%).

Conclusions

It is evident that in most cases of deaths in women due to thermal injuries, the entire narrative is not thoroughly investigated and any prior history of domestic abuse, dowry demands/harassment, and even mental illnesses gets under-reported or undocumented. Despite there being a plethora of information regarding the statistics as to how women die due to thermal injuries, very minimal data exists regarding the measures adopted to prevent it. There is a hope that this study inspires the concerned stakeholders to take stock and introduce measures to prevent such potential deaths among the vulnerable female population.

The effect of self-inflicted burns on ABSI score prediction power: A four-year prospective multicenter study of the German Burn Registry

BACKGROUND

Suicide attempted by self-inflicted burns are associated with lower survival rates compared to accident related burns.

OBJECTIVE

We investigate the relation between self-inflicted burns (SIB) and survival rates and how this relation is moderated by variables used to predict survival rates in the ABSI score, a widely used measure. Additionally, we compare the predicted survival rates by the ABSI score to the actual rates in our sample for SIB and accident patients.

METHODS

In this prospective multicenter study data from the German Burn Registry are statistically analyzed using two sided t-test and multivariate linear regression models.

RESULTS

5330 patients (214 with SIB) met our inclusion criteria. We find a 6.8 percentage points lower survival rate for patients with SIB when we control for patient condition with the five ABSI components as covariates. These higher mortality rates can be explained by the higher rate of therapy restrictions for patients with self-inflicted burns. Additionally, different ABSI modifications can improve the predictive power of the score.

CONCLUSION

Patients with SIB have lower survival rates compared to accident patients. Recently proposed modifications of the ABSI score can improve the accuracy of survival rate prediction for SIB.

Psychosocial Determinants of Burn-Related Suicide: Evidence From the National Violent Death Reporting System

Suicide is a unique phenomenon in humans. In 2017, over 47,000 Americans died by suicide, prompting a public health crisis. Suicide by burning, while one of the rarest forms of suicide, could be mitigated in part by early recognition and treatment of the underlying psychosocial factors. To date, investigators have attempted to tease out the risk factors associated with this phenomenon through the examination of burn center chart reviews and repository data, but these studies were limited by small sample sizes. In order to fill this gap in the literature, the authors analyzed 14 years of data (2003-2016) from the National Violent Death Reporting System. Suicides by burning (n = 722) were compared with a reference group containing all other suicide types (n = 166,949). Socio-demographic variables and psychosocial factors (eg, mental health, substance use, and alcohol use) were included in the model. Due to the imbalance between the target and reference groups, rare event data analysis was used to reduce potential small sample estimation bias. Results indicated that females (OR = 1.6, 95% CI: .50-2.83, P < .001), Caucasians (OR = 1.7, 95% CI: 1.1-2.7, P < .001), victims with schizophrenia (OR = 5.4, 95% CI: 3.7-7.8, P < .001), and victims with eating disorders (OR = 5.6, 95% CI: 1.9-8.6, P < .001) are significantly more likely to commit suicide by burning. These results contribute new knowledge to what is currently known about suicidal burn-related behaviors and supports interventions that focus on mitigating this insidious public health problem.

Length of hospital stay and mortality associated with burns from assault: a retrospective study with inverse probability weighting analysis

Background

Burns resulting from assaults account for considerable morbidity and mortality among patients with burn injuries around the world. However, it is still unclear whether unfavorable clinical outcomes are associated primarily with the severity of the injuries. To elucidate the direct relationship between burns resulting from assaults and mortality and/or length of hospital stays, we performed this study with the hypothesis that burns from assault would be independently associated with fewer hospital-free days than would burns from other causes, regardless of the severity of burn injuries.

Methods

We conducted a retrospective cohort study, using a city-wide burn registry (1996-2017) accounting for 14 burn centers in Tokyo, Japan. Patients who arrived within 24 hours after injury were included, and those with self-inflicted burn injuries were excluded. Patients were divided into two groups according to mechanism of burns (assault vs. accident), and the number of hospital-free days until day 30 after injury (a composite of in-hospital death and hospital length of stay) was compared between the groups. To estimate the probability that an injury would be classified as an assault, we calculated propensity scores, using multivariate logistic regression analyses adjusted for known outcome predictors. We also performed an inverse probability weighting (IPW) analysis to compare adjusted numbers of hospital-free days.

Results

Of 7419 patients in the registry with burn injuries during the study period, 5119 patients were included in this study. Of these, 113 (2.2%) were injured as a result of assault; they had significantly fewer hospital-free days than did those with burns caused by accident (18 [27] vs. 24 [20] days; coefficient = [Formula: see text]3.4 [[Formula: see text]5.5 to [Formula: see text]1.3] days; p = 0.001). IPW analyses similarly revealed the independent association between assault burn injury and fewer hospital-free days (adjusted coefficient = [Formula: see text]0.6 [[Formula: see text]1.0 to [Formula: see text]0.1] days; p = 0.009).

Conclusions

Burn from assault was independently associated with fewer hospital-free days, regardless of the severity of burn injuries. The pathophysiological mechanism underlying the relationship should be further studied in a prospective observational study.

Examining the Impact of Psychological Factors on Hospital Length of Stay for Burn Survivors: A Systematic Review

Recovery of burn patients may be impeded by mental health problems. By gaining a better understanding of the impact that psychological factors may have on hospital length of stay, providers may be better informed to address the complex needs of burn survivors through effective and efficient practices. This systematic review summarizes existing data on the adverse psychological factors for the length of burn patients' hospitalization, and assesses the methodological quality of the extant literature on mental health conditions of burn survivors. A literature search was conducted in four electronic databases: PubMed, PsychINFO, Science Direct, and the Cumulative Index to Nursing and Allied Health Literature. Results yielded reports published between 1980 and 2016. Methodological quality was assessed by using an 11-item methodological quality score system. Seventy-four studies were identified by search; 19 articles were eligible for analysis. Findings demonstrate paucity of evidence in the area. Reports indicate longer hospital stay among burn patients with mental health problems. Substance use was the most consistent mental-health predictor of longer hospital stay. Heterogeneity in data on mental health conditions rendered impossible estimation of effect sizes of individual psychological factors on length of hospitalization. Many studies over-relied on retrospective designs, and crude indicators of psychological factors. Findings indicate that mental health problems do have an impact on the trajectory of burn recovery by increasing the length of hospital stay for burn survivors. Inpatient mental health services for burn patients are critically needed. Prospective designs, and more sensitive psychological indicators are needed for future studies.

The epidemiologic characteristics and outcomes following intentional burn injury at a regional burn center

INTRODUCTION

Intentional burn injury outcomes are usually more severe, have a high mortality and are seen more often in low and middle-income countries. This study will examine the epidemiological characteristics of intentional burn injury patients and mortality outcomes at a regional Burn Center.

METHODS

This is a retrospective study of 11,977 patients admitted to a regional Burn center from 2002 to 2015.Variables analyzed were basic demographics (sex, age, and race), total body surface area of burn (%TBSA), presence of inhalation injury, Charlson comorbidity index, intent of injury, mortality, and hospital and ICU length of stay (LOS). Chi-square tests, bivariate analysis and logistic regression models were utilized to determine the effect of burn intent on outcomes.

RESULTS

Eleven thousand eight hundred and twenty-three (n = 11,823) adult and pediatric patients from 2002 to 2015 were included in the study. Three hundred and forty-eight (n = 348, 2.9%) patients had intentional burn injuries (IBI). Patients with IBI were younger, 26.5 ± 20 years compared to the non-intentional burn injury (NIBI) group (32 ± 22 years, p < 0.001). Mean %TBSA was significantly higher in the IBI vs. NIBI group at 14.6 ± 20 vs. 6.4 ± 10%, p < 0.001, respectively. Overall, Non-whites (n = 230, 66%) were more likely to have IBI, p < 0.001. Inhalation injury and mortality were statistically significant in the IBI group compared to the NIBI group, (n = 54,16%) vs. (n = 30, 9%) and (n = 649,6%) vs. (n = 329,2.9%), p < 0.001, respectively. Multivariate logistic regression did not show any significant increase in odds of mortality based on burn intent. In subgroup analysis of self-inflicted (SIB) vs. assault burns, SIB patients were significantly older, 38 years (±14.7) vs. 22.4 years (±20.5), p < 0.001 and had a higher %TBSA, 26.5 (±29.6) vs. 10.3 (±13.6), p < 0.001. Seventy three percent (n = 187, 73%) of assault burn patients were Nonwhite and Whites were more likely to incur self-inflicted burns, (n = 53% p < 0.001).

CONCLUSION

We show that patients with intentional burn injuries have an associated increased %TBSA and inhalation injury without increased adjusted odds for mortality. Intentional burns increase health care expenditures. Violence prevention initiatives and access to mental health providers may be beneficial in reducing intentional burn injury burden.

Incidence of self-inflicted burn injury in patients with Major Psychiatric Illness

INTRODUCTION

Psychiatric disorders are mental illnesses that impair judgment, thought process and mood that can result in physical and emotional disability. According to DSM-IV, mental disorders increases risk of traumatic injury, particularly burn [1] (American Psychiatric Association, 2013). However, there are few studies that look at patients with pre-existing major psychiatric disorders and burn outcomes. We aim to assess the incidence and intentionality of burn injury in patients with pre-existing psychiatric disorders.

METHODS

This is a retrospective study of patients admitted to the UNC Jaycee Burn Center from 2002 to 2015 and entered in the burn registry. Variables analyzed include basic demographics, insurance status, total body surface area (TBSA) of burn, Charlson comorbidity index (CCI), burn etiology, presence of inhalation injury, burn circumstance, intensive care unit (ICU) and hospital length of stay (LOS) and mortality. Chi-square, Analysis of Variance (ANOVA), Kruskal-Wallis test and Multivariate logistic regression was used to analyze the data.

RESULTS

11,650 adult and pediatric patients were entered in the burn registry from 2002 to 2015 and 494 (4.2%) adult and pediatric patients had preexisting major psychiatric illness (MPI). Within the large cohort of admitted burn patients, 90 (0.8%) patients presented with self-inflicted burn injuries. 41% of patients with SIB (n=37/90) had MPI. The incidence of self-inflicted burn injury (SIB) within the MPI (n=494) cohort was 7.5% (n=37). Mean age of patients with and without self-inflicted burn injury was 35.3 (±11.6) vs. 41.8 (±17.3), respectively. Mean TBSA was significantly higher in patient with SIB at 18.6 (±16.5) vs. 8.5(±12.2) p<0.001. Non-white race had significantly higher rate of SIB compared to white cohort. There was no significant difference in mortality rates between SIB and Non-SIB (5.4% vs. 3.7%, p=0.609), respectively. Median Hospital LOS was significantly increased in patients with SIB compared to NSIB 31 (IQR=55) vs. 9 (IQR=20) days, p=0.004. Multivariate logistic regression for predictors of self-inflicted burn injury showed that minorities were more likely to incur self-inflicted burn injury among patients with major psychiatric illnesses.

CONCLUSION

The incidence of self-induced burn injury in patients with MPI is low and of all the self-inflicted burn patients, 60% did not have a major psychiatric illness identified. Our findings emphasize the importance of identifying patients with MPI with or without self-induced injury that may benefit from more extensive psychiatric screening after burn and counseling, particularly minority patients as they may benefit from additional mental health counseling following severe burn.

A population-based comparison study of the mental health of patients with intentional and unintentional burns

Background

A number of studies report high prevalence of mental health conditions among burn patients. However there is a need to understand differences in the temporal relationship between mental health conditions and intentional and unintentional burns to hasten psychological prevention and intervention. This study aims to compare the socio-demographic profile, burn characteristics and pre- and post-burn psychiatric morbidity of burn patients by intent-of-injury.

Methods

De-identified linked hospital, death and mental health (MH) case registry data of burn patients hospitalised in Western Australia between 1 January 1980 and 30 June 2012 were analysed. Crude (observed) post-burn rates of mental health admissions were generated by burn intent-of-injury. Descriptive statistics were performed to compare the characteristics of the burn patients.

Results

A total of 30,997 individuals were hospitalised for a first burn; 360 (1.2%) had self-harm burns and 206 (0.7%) assault burns. Over the study period, admission rates for assault burns increased by 4.8% per year (95% confidence interval (CI) 3.1–6.5%) and self-harm burns increased 6.9% per year (95% CI 4.8–9.1%). Self-harm and assault burns occurred mainly among those aged 15 to 44 years (median age, interquartile range (IQR): self-harm 30 years, 22–40; assault 31 years, 23–38). Those with self-harm burns had a longer index hospital stay (median (IQR): self-harm 15 days (5–35) vs 4 days (1–11) assault vs 4 days (1–10) unintentional) and higher in-hospital mortality (7.2% self-harm vs 1.9% assault burns vs 0.8% unintentional). More than half (55.0%) of self-harm burns had a prior hospitalisation (5-year lookback) for a MH condition vs 10.7% of assault burns and 2.8% of unintentional burns. Crude post-burn rates of MH admissions per 100 person-years (PY) by intent-of-burn subgroups: self-harm 209 per 100 PY, assault burns 11 per 100 PY and unintentional burns 3 per 100 PY.

Conclusions

Intentional burn patients experienced significantly higher pre- and post-burn mental health morbidity along with significant adverse outcome in comparison with unintentional burns. Early psychological assessment and intervention could help in improving the MH of these patients.

Epidemiology and financial implications of self-inflicted burns

INTRODUCTION

The cost of the treatment of burns is high especially in self-inflicted burns with prolonged treatment. We performed a retrospective review of the self-inflicted burns at our regional burns centre to determine the costs incurred in their management and to identify factors which could reduce the financial burden in the future.

METHODS

The data was collected retrospectively of all the inpatient and outpatient self-inflicted burns presenting to our regional burns centre in the year 2011.

RESULTS

Twenty one patients (out of a total of 870 patients) presented with self-inflicted burns to our centre in 2011. Five (23.8%) were major burns with an average of 53.2% Total Body Surface Area (TBSA) and 16 (76.2%) were minor burns with an average of 0.5% TBSA. 11 (52.4%) patients had flame burns including 4 self-immolation burns. The mortality rate was 4.8% (n=1). Five (23.8%) patients underwent surgical treatment. Seven (33.3%) patients were treated in intensive care and with average stay of 46.85 days. Critical care and theatre attendances made up most of the costs with average ICU stay per patient calculated at £313,131/day. The total cost of all 21 patients was £1,581,856.

CONCLUSION

Burns are preventable injuries, early detection and intervention in patients with propensity to self-inflict burns can possibly reduce the costs of treatment in the future.

Intentional burns in Nepal: a comparative study

AIMS

Intentional burns injuries are associated with high mortality rates, and for survivors, high levels of physical and psychological morbidity. This study provides a comprehensive assessment of intentional burn admissions to the adult Burns Unit at Bir Hospital, Kathmandu, Nepal, during the period 2002-2013.

METHODS

A secondary data analysis of de-identified data of patients hospitalized at Bir Hospital, Kathmandu, with a burn during the period of 1 January 2002 to 31 August 2013. Socio-demographic, injury and psychosocial factors of patients with intentional and unintentional burns are described and compared. Chi-square tests, Fisher's exact test and Wilcoxon rank sum tests were used to determine statistical significance.

RESULTS

There were a total of 1148 burn admissions of which 329 (29%) were for intentional burn, 293 (26%) were self-inflicted and 36 (3%) were due to assault. Mortality rates for intentional burns were approximately three times those for unintentional burns (60 vs. 22%). When compared to unintentional burns, patients with intentional burns were more likely to be female (79 vs. 48%), married (84 vs. 67%), younger (25 vs. 30 years), have more extensive burns (total body surface area, %: 55 vs. 25) and higher mortality (60 vs. 22%). Intentional burns were more likely to occur at home (95 vs. 67%), be caused by fire (96 vs. 77%), and kerosene was the most common accelerant (91 vs. 31%). A primary psychosocial risk factor was identified in the majority of intentional burn cases, with 60% experiencing adjustment problems/interpersonal conflict and 32% with evidence of a pre-existing psychological condition. A record of alcohol/substance abuse related to the patient or other was associated with a greater proportion of intentional burns when compared with unintentional burns (17 vs. 4%).

CONCLUSIONS

The majority of intentional burn patients were female. Almost all intentional burns occurred in the home and were caused by fire, with kerosene the most common accelerant used. Underlying psychosocial risk factors were identified in most cases. Intentional burns resulted in severe burns with high mortality. Intentional burns are not only a serious medical issue; they represent significant public health and gender issues in Nepal.

The spectrum and outcome of burns at a regional hospital in South Africa

INTRODUCTION

Burns remain a major cause of morbidity and mortality in Southern Africa. The more vulnerable of our population, namely the urban poor, children and epileptics, are most often affected. This audit documents our experience with burns in a busy regional hospital in Southern Africa.

PATIENTS AND METHODS

A prospective data base was maintained from September 2006 to February 2008 of all burn wound patients admitted in Edendale hospital. Standard demographic data, detailed description of the burn, surgical intervention, outcome and length of stay are recorded. The size and depth of the burn, as well as the initial fluid management are also recorded.

RESULTS

A total of 450 patients were admitted. Two hundred and thirty-five were male. There were 203 burnt children with an average age of 3 years (range 6 months to 12 years). Average age for adults was 40 years (range 13-82 years). The average surface area burnt in children was 7.5% versus 23% in adults. Of those who died, the average surface area burnt was 54%. In adults the average burn depth was superficial in 30%, deep dermal in 20% and full thickness in 50%. The aetiology of the burn was flame 70%, hot water 25% and miscellaneous 5%. In children the breakdown of burn depth was superficial in 77%, deep dermal in 15% and full thickness in 8%. The aetiology was hot water 83%, fire 6%, electrical 6% and miscellaneous 5%. The last mentioned included hot oil or porridge (15), electrical (10), chemical (6), flash burns (8) and lightning (4). Fifty percent of adults were epileptic and had sustained their burn wound during a seizure. In this group, over 40% had previously sustained burns. Fifteen percent had a delayed presentation on an average of 11 days. Hospital stay averaged 68 days (3.5 days per percent burn: range 1-161 days). Two hundred and two (45%) patients required skin grafting. The average time from burn to graft was 51 days (range 12-138). There were 40 deaths (9%) with an average age of 50 years (range 6 months to 82 years) and an average total burn surface area of 50% (range 14-85%). Aetiology of the burn in the deaths was fire in 30, lightning 4 and hot water 6. Cause of death was burn wound sepsis in 38 and inadequate resuscitation in 2.

CONCLUSION

Young children and epileptics are particularly vulnerable to sustaining burns. Our hospital sees a large number of burns predominantly involving smaller surface areas. Patients with small burns have a prolonged hospital stay and delayed grafting due to a conservative surgical approach and lack of resources. Large burns are fatal in our hands.

Implications of formal alcohol screening in burn patients

The purpose of this study was to screen burn patients for alcohol use disorders to identify those at increased risk for repeat injury and adverse effects of alcohol use. We examined associations of at-risk drinking and dependence symptoms as measured by a formal screening tool and blood alcohol concentration (BAC) to guide further screening, treatment, and research. We hypothesized that the majority of drinkers would not have symptoms of alcohol dependence, that BAC would be inadequate to screen for alcohol disorders, and that at-risk drinkers would be more likely to be unemployed and uninsured than healthy drinkers. Formal screening of English speakers, age 16 to 75, admitted to the burn service for over 24 hours was conducted for a 6-month period, using the Alcohol Use Disorders Identification Test. Of the 123 patients eligible for the study, 110 (89.4%) were approached for formal screening, four refused (3.6%), and 13 were missed (10.6%). BAC was obtained in 68 of 110 (61.8%); no patient who reported abstinence had a positive BAC. Of the 106 screened, 34.9% were nondrinkers, 11.3% drank daily or almost daily, and 28.3% binge drank at least monthly (>4 drinks per occasion for men, >3 for women). Of the patients who drank, only eight patients reported one or more sign of dependence in the last year (11.6%). For the group as a whole, 20.9% met Alcohol Use Disorders Identification Test criteria for at-risk drinking, with an average BAC of 39.8 mg/dl, (range 0-242 mg/dl). Using BAC of >or=80 mg/dl, only 5.6% of patients would have been identified as at-risk drinkers. Twenty-three percent of patients had no health insurance, 36% of whom were at-risk drinkers compared with 17.3% of insured patients (P < .05). For the group as a whole, 41.8% of patients were unemployed. At-risk drinking did not differ between employed and unemployed patients (24.6% vs 17.8%, P > .05). Among burn patients, formal alcohol screening identified that one in five patients is at risk for further problems from their drinking and that most at-risk drinkers are binge drinkers and do not show signs of dependency. Formal screening identified more at-risk drinkers than BAC. Implications of the screening findings are 1) because most burn patients who drink are binge but not dependent drinkers, alcohol withdrawal should be infrequent, and 2) animal models of alcohol use and burn injury should study acute intoxication and binge exposure. In addition, 3) we would expect burn patients to respond to brief interventions for alcohol use disorders similar to trauma and primary care patients.

Mortality risk and length of stay associated with self-inflicted burn injury: evidence from a national sample of 30,382 adult patients

OBJECTIVE

Existing studies report contradictory findings regarding characteristics and outcomes of patients admitted with self-inflicted burn injuries. The objective of this study was to report demographic and medical characteristics of patients admitted to burn centers with self-inflicted burn injuries and to assess mortality risk and length of stay compared with patients whose injuries were not self-inflicted.

DESIGN

Retrospective, cohort study.

SETTING

A total of 70 burn centers from the United States that contributed data to the American Burn Association National Burn Repository.

PATIENTS

A total of 30,382 adult patients (593 with self-inflicted injuries) who were admitted with a thermal injury from 1995 through 2005.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Demographics, comorbidities, burn injury severity variables (total body surface area burned [TBSA], TBSA burned third degree, inhalation injury), hospital mortality, intensive care length of stay, and total hospital length of stay were ascertained. Patients with self-inflicted injuries had larger TBSA burned (32.0% vs. 12.8%, p < .01) and larger third-degree TBSA burned (20.6% vs. 4.9%, p < .01) and were more likely to incur an inhalation injury (37.3% vs. 12.8%, p < .01). Before matching, patients with self-inflicted injuries were at greater risk of mortality (23.6% vs. 6.8%, p < .01) and required longer intensive care (median of 4 days vs. 0 days, p < .01) and total hospital stays (median of 23 days vs. 8 days, p < .01). After propensity score matching on demographic, medical, and burn injury variables, they were not more likely to die of their injuries (23.6% vs. 23.1%, p = .84), did not require longer intensive care stays (4 days vs. 3 days, p = .75), and did not require longer total hospital stays (23 days vs. 18 days, p = .50).

CONCLUSIONS

Compared with patients with similar demographic, health, and injury characteristics whose injuries are not self-inflicted, patients with self-inflicted burn injuries are not at greater risk of mortality and do not require longer durations of intensive care or total hospitalization.