K. D. Atwell1, C. Bartley1, B. Cairns1, A. Charles1 1University Of North Carolina At Chapel Hill,Department Of Surgery,Chapel Hill, NC, USA
Introduction: The predictors of burn mortality have been well studied, which include age, burn size, presence of inhalational injury and pre-existing comorbidities. There are limited studies that describe the role of burn injury intentionality on mortality outcome. Intentional burn injury outcomes are usually more severe, have a high mortality and are seen more often in low and middle income countries.1,2 This study will examine the epidemiological characteristics of intentional burn injury patients and mortality outcome at the UNC Jaycee Burn Center in North Carolina.
Methods: A retrospective study of patients admitted to the UNC Jaycee Burn Center from 2002-2015. Variables analyzed were basic demographics, total body surface area (TBSA) of burn, type of burn, presence of inhalation injury, Charlson comorbidity index (CCI), burn intent, mortality and intensive care unit (ICU) and hospital length of stay (LOS). Chi-square tests, bivariate analysis and logistic regression models were used to determine statistical significance between the two study groups.
Results:11,786 adult and pediatric patients from 2002-2015 were included in the study. 348 (3%) patients had intentional burn injuries (IBI). Patients with IBI had a lower mean age of 26.5 ±20.4 vs. 32 ±22 in the non-intentional burn injury (NIBI) group, 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. Non-whites (66%) were more likely to have IBI compared to Whites (34%), p<0.001. Inhalation injury and mortality were statistically significant in the IBI burn cohort, 16% (n=54) and 9% (n=30), respectively vs. 6% (n=647) and 2.9% (n=329) in the NIBI group, respectively, p<0.001. Median hospital LOS was significantly higher in IBI patients compared to NIBI patents, 10 days (IQR=22) vs. 5 days (IQR=10), p<0.001. Median ICU LOS was also significantly higher in IBI patients compared to NIBI patents, 7 days (IQR=33) vs. 3 days (IQR=10), p<0.001. Multivariate logistic regression for odds ratio showed that IBI patients have a 2.6x increased odds of mortality, an increased hospital LOS of over twice the mean LOS and a prolonged ICU LOS 1.6x over the mean ICU LOS.
Conclusion:Our study findings showed that patients with intentional burn injuries have high burn injury severity attributable to the associated increased %TBSA and Inhalation injury. Furthermore, patients with intentional burn injury have higher odds of mortality and increased ICU and hospital LOS. Intentional burns, both self-harm or assault burns, increase health care expenditures attributable to additional resources for medical, psychiatric, social services and other health care expenses. There must be a high index of suspicion for intentional injury for large %TBSA burn and associated inhalation injury. Violence prevention initiatives that target the male and minority demographic may be beneficial in reducing intentional burn injury burden.