Incidence, survival pattern and prognosis of self-immolation: a case study in Iran

Abstract

Aim: Our aim was to describe the survival pattern and prognostic predictors of individuals attempting suicide by self-immolation. Subjects and methods: We performed a cohort study of all self-immolation subjects diagnosed/registered between 1988 and 2004 in the Sina University Hospital of the Tabriz University of Medical Sciences, Tabriz, Iran. Cases were followed from diagnosis/admission to recovery or death. Results: Of 117 cases, 91 died, giving a case fatality rate of 78% (95% CI: 69-84). Most subjects were married (58%), female (78%) and from urban areas (66%). The proportion of subjects surviving to 2 and 6 weeks were 29% and 5%, respectively. Most deaths occurred in the early days after the event. Univariate analysis revealed survival to be significantly lower in subjects with more than 75% burns in the total surface body area (TSBA) (P=0.0001), those with burns in the head and neck (P=0.003), and in the trunk (P=0.004), genital organs (P=0.027), upper limbs (P=0.013) and lower limbs (P=0.0001). No statistical differences in survival were observed by gender, marital status, residence status, tools used for suicide, income, history of family conflict, age or weight. Using the Cox proportional hazard model, cases with more than 75% burns in TSBA (RR=2.6, 95% CI: 1.6-4.3), those with burns in the head and neck (RR=2.5, 95% CI: 1.1-5.2), and those with burns in the lower limbs (RR=5.8, 95% CI: 2.2-14.9) were at higher risk of dying than others. Conclusion: One in ten subjects attempting suicide by self-immolation survives for at least 5 weeks. Further epidemiological and qualitative studies are required to determine prognosis more precisely, and to elucidate the public health impacts and socio-economic origins of such tragic events, as well as health care needs and preventive strategies in high risk populations.

Survival probability in self immolation attempters: a prospective observational cohort study

“…The findings of this study demonstrated that the highest mortality rate of self-immolation was in the first 24 hours after accident. Similar results have been obtained in similar studies, [12,19] and it is believed that the most important cause of mortality of self-immolation in the first 24 hours is loss of fluids and electrolytes. Therefore, the first step for the survival of a patient should be compensating lost fluids and electrolytes, especially compensating half of the lost fluids during the first 8 hours after self-immolation.…”

“…In similar studies, mostself-immolation cases were carried out by petroleum. [7,19] Our study researchers expected a positive relationship between the caustic agent and survival rate, but as demonstrated in Table 1, there was no meaningful relation between caustic agent and survival rate of self-immolation attempters in the univariate and multivariate analysis.…”

Epidemiology of burn injuries in the East Mediterranean Region: a systematic review

“…Factors associated with mortality according to individual studies include older age (60 and over), a greater TBSA burnt, female gender, depth of burn and delay in receiving medical care[ 29 ]; TBSA burnt and age [ 33 ]; inhalation, delay and female gender [ 49 ], TBSA burnt and inhalation[ 50 ], TBSA burnt, flame, female gender and age[ 18 ]; and TBSA burnt and head and neck burns [ 51 ]. Mortality for flame injuries is much higher than for scald injuries.…”

Decadorial of a burn center in Central India

“…These data are also consistent with Dastgiri et al . [ 26 ] where higher risk of death was observed with higher TBSA > 75%. Indeed every 1% increase in TBSA is significantly associated with 6% increase in risk of death.…”