The Epidemiologic Characteristics and Outcomes Following Intentional Burn Injury at a Regional Burn Center

Overview

Journal Burns

Publisher Elsevier

Date 2019 Aug 29

PMID 31455546

Citations 3

Authors

Kenisha Atwell

Colleen Bartley

Bruce Cairns

Anthony Charles

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

EPIDEMIOLOGICAL CHARACTERISTICS AND FACTORS ASSOCIATED WITH MORTALITY IN SEVERELY BURNED PATIENTS - CROATIAN NATIONAL BURN CENTER REPORT.

Skunca A, Mesic A, Magdic Turkovic T, Radocaj T, Potocki S Acta Clin Croat. 2024; 62(1):115-122.

PMID: 38304358 PMC: 10829945. DOI: 10.20471/acc.2023.62.01.14.

Prevalence of non-accidental burns and related factors in children: A systematic review and meta-analysis.

Hermis A, Tehrany P, Hosseini S, Firooz M, Hosseini S, Jamshidbeigi A Int Wound J. 2023; 20(9):3855-3870.

PMID: 37224877 PMC: 10588353. DOI: 10.1111/iwj.14236.

Treatment Decisions in Patients With Potentially Nonsurvivable Burn Injury in Australia and New Zealand: A Registry-Based Study.

Tracy L, Gold M, Reeder S, Cleland H J Burn Care Res. 2022; 44(3):675-684.

PMID: 35170735 PMC: 10152993. DOI: 10.1093/jbcr/irac017.

References

Herndon D, Barrow R, Rutan R, Rutan T, Desai M, Abston S . A comparison of conservative versus early excision. Therapies in severely burned patients. Ann Surg. 1989; 209(5):547-52; discussion 552-3. PMC: 1494069. DOI: 10.1097/00000658-198905000-00006. View

Toon M, Maybauer D, Arceneaux L, Fraser J, Meyer W, Runge A . Children with burn injuries--assessment of trauma, neglect, violence and abuse. J Inj Violence Res. 2011; 3(2):98-110. PMC: 3134932. DOI: 10.5249/jivr.v3i2.91. View

Battle C, Evans V, James K, Guy K, Whitley J, Evans P . Epidemiology of burns and scalds in children presenting to the emergency department of a regional burns unit: a 7-year retrospective study. Burns Trauma. 2016; 4:19. PMC: 4964307. DOI: 10.1186/s41038-016-0047-7. View

Malic C, Karoo R, Austin O, Phipps A . Burns inflicted by self or by others--an 11 year snapshot. Burns. 2006; 33(1):92-7. DOI: 10.1016/j.burns.2006.04.008. View

Nisavic M, Nejad S, Beach S . Intentional Self-inflicted Burn Injuries: Review of the Literature. Psychosomatics. 2017; 58(6):581-591. DOI: 10.1016/j.psym.2017.06.001. View

Bitsko R, Holbrook J, Robinson L, Kaminski J, Ghandour R, Smith C . Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders in Early Childhood - United States, 2011-2012. MMWR Morb Mortal Wkly Rep. 2016; 65(9):221-6. DOI: 10.15585/mmwr.mm6509a1. View

Reed J, Pomerantz W . Emergency management of pediatric burns. Pediatr Emerg Care. 2005; 21(2):118-29. DOI: 10.1097/01.pec.0000159058.95424.0d. View

Peck M . Epidemiology of burns throughout the World. Part II: intentional burns in adults. Burns. 2012; 38(5):630-7. DOI: 10.1016/j.burns.2011.12.028. View

Joory K, Farroha A, Moiemen N . Is a self-inflicted burn part of a repeated self-harm pattern?. Ann Burns Fire Disasters. 2016; 28(3):223-7. PMC: 4883609. View

10.

Natarajan M . Differences between intentional and non-intentional burns in India: implications for prevention. Burns. 2014; 40(5):1033-9. DOI: 10.1016/j.burns.2013.12.002. View

11.

Cornet P, Niemeijer A, Figaroa G, van Daalen M, Broersma T, van Baar M . Clinical outcome of patients with self-inflicted burns. Burns. 2017; 43(4):789-795. DOI: 10.1016/j.burns.2016.11.005. View

12.

Maguire S, Moynihan S, Mann M, Potokar T, Kemp A . A systematic review of the features that indicate intentional scalds in children. Burns. 2008; 34(8):1072-81. DOI: 10.1016/j.burns.2008.02.011. View

13.

Olaitan P, Jiburum B . Chemical injuries from assaults: An increasing trend in a developing country. Indian J Plast Surg. 2009; 41(1):20-3. PMC: 2739541. DOI: 10.4103/0970-0358.41106. View

14.

Modjarrad K, McGwin Jr G, Cross J, Rue 3rd L . The descriptive epidemiology of intentional burns in the United States: an analysis of the National Burn Repository. Burns. 2007; 33(7):828-32. DOI: 10.1016/j.burns.2006.11.006. View

15.

Dhopte A, Tiwari V, Patel P, Bamal R . Epidemiology of pediatric burns and future prevention strategies-a study of 475 patients from a high-volume burn center in North India. Burns Trauma. 2017; 5:1. PMC: 5286678. DOI: 10.1186/s41038-016-0067-3. View

16.

Saaiq M, Zaib S, Ahmad S . Early excision and grafting versus delayed excision and grafting of deep thermal burns up to 40% total body surface area: a comparison of outcome. Ann Burns Fire Disasters. 2013; 25(3):143-7. PMC: 3575152. View

17.

Rietschel C, Reese J, Hahn A, Fauerbach J . Clinical and psychiatric characteristics of self-inflicted burn patients in the United States: comparison with a nonintentional burn group. J Burn Care Res. 2014; 36(3):381-6. DOI: 10.1097/BCR.0000000000000100. View

18.

Puri V, Khare N, Chandramouli M, Shende N, Bharadwaj S . Comparative Analysis of Early Excision and Grafting vs Delayed Grafting in Burn Patients in a Developing Country. J Burn Care Res. 2013; 37(5):278-82. DOI: 10.1097/BCR.0b013e31827e4ed6. View

19.

Ali S, Soueid A, Rao K, Moiemen N . Self-inflicted burns, outcome and cost. Burns. 2006; 32(4):463-6. DOI: 10.1016/j.burns.2005.11.001. View

20.

Ho W, Ying S, Chan H, Chow C . Assault by burning--a reappraisal. Burns. 2001; 27(5):471-4. DOI: 10.1016/s0305-4179(00)00159-5. View