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

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 AE 20 years compared to the non-intentional burn injury (NIBI) group (32 AE 22 years, p < 0.001). Mean %TBSA was significantly higher in the IBI vs. NIBI group at 14.6 AE 20 vs. 6.4 AE 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 (AE14.7) vs. 22.4 years (AE20.5), p < 0.001 and had a higher %TBSA, 26.5 (AE29.6) vs. 10.3 (AE13.6), 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.

Epidemiological Characteristics and Factors Associated with Mortality in Severely Burned Patients – Croatian National Burn Center Report

“…A commonly used method for estimating burn LOS is 1 day of hospitalization per TBSA burned ( 13 , 14 ). In our study, the mortality rate ( 5 , 7 , 9 , 15 ) and the LOS/TBSA ratio were high and exceeded those reported in relevant literature ( 3 , 7 , 14 ), possibly because of a high percentage of inhalation injury, advanced patient age, not including pediatric patients, and using a sample of severely burned adult patients admitted to the BICU. For example, a systematic review of burn injuries in the East Mediterranean Region reports on the ages between 18 to 25 years with TBSA burned between 10% to 48% ( 15 ), which is lower than the mean age and mean TBSA in our study group.…”

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

“…The current data do not support this anecdotal evidence, with no observed association between injury intent and the initiation of active treatment after accounting for other relevant factors. Intentional burn injuries have been reported to affect a greater percentage of TBSA, 8 , 39 but the association with increased odds of mortality has been debated. 39 Further research into how injury intent affects end of life decision-making processes is required.…”

“…Intentional burn injuries have been reported to affect a greater percentage of TBSA, 8 , 39 but the association with increased odds of mortality has been debated. 39 Further research into how injury intent affects end of life decision-making processes is required. Our finding that a smaller proportion of patients who received palliative management from the outset of their admission had a CCI weight ≥1 (compared to the other two treatment groups) is counterintuitive and should be investigated in greater detail in future studies.…”

Variables Influencing the Differential Host Response to Burns in Pediatric and Adult Patients

“…Regarding location of injury, two thirds of pediatric burns take place at home (3,6), compared with half of adult burns (due to a significant proportion of injury at the workplace) (5). Rates of intentional burn injury (abuse and selfharm) are also significantly higher in children (up to 20%) compared with adults (2%) (7,8).…”