This study examines the link between patients presenting with self-inflicted burns (SIB) and key outcomes including length of stay (LOS) and mortality. The authors describe current ambiguity in the literature relating to this topic in burns care. They highlight similar work by Thombs and Bresnick who looked at psychiatric patients with accidental burns and those with self-inflected burns and found no difference in LOS or mortality. The authors believe that including psychiatric diagnosis in regression analysis skewed their results and as a result they proceed by comparing / matching SIB with all accidental burns. The authors retrospectively reviewed a prospective database of all adult patients presenting to a single unit in the Netherlands over a five year period. They stratified self-inflicted burns into suicide attempts (SA) vs. non-suicidal self-injury (NSSI). They also collected information on psychiatric diagnosis. To evaluate differences in outcome SIB patients were matched on variables and abbreviated burns severity index (ABSI) to patients with accidental burns. A total of 557 acute burns admissions were reviewed. This included 21 SA and eight NSSI. A higher mortality was found in the SA group thought to be due to higher % total burns surface area (TBSA), higher % of full thickness burns / inhalation injuries compared to the total population. The outcome of patients who attempted suicide or harmed themselves without intention to die appears to be related to severity of burn irrespective of pychiatric / medical co-morbidities. SIB group stayed longer in hospital (27 days vs.15-16 days). No statistical difference in SA vs. SA matched LOS was found. Surprisingly, no difference in LOS between SA and NSSI groups was found.
This paper examines a relatively uncommon presentation to any western burns unit and as such the small size of the SIB group is a study limitation, especially when looking at statistical significance. The second limitation, as with many similar studies, is the use of a retrospective data set limited by not being designed for purpose and traditionally associated with missing data. The exact clinical implication of this study is clear. It may serve to highlight the multidisciplinary team (MDT) approach and early psychiatric input to stratify intention of harm and guide inpatient management and prognosis for families. Despite existing literature in this area, the authors take a unique approach by attempting to control for variables affecting key clinical burns outcomes between groups. Assuming timely treatment, the authors conclude that, mortality or LOS could be explained by % TBSA and intent of the patient.
