Burns with Intent: A Retrospective Analysis of Self-Inflicted Burn Injuries.

Self-inflicted burns (SIB) comprise a significant and yet minimally researched area within burn injuries and are often associated with complex psychiatric conditions, high morbidity and mortality. SIB are often associated with higher total body surface area (TBSA) burns, inhalational injuries, and length of stay. This study seeks to investigate the demographics, clinical outcomes, and psychiatric comorbidities of SIB patients treated at a tertiary care burn center between 2011 and 2021. We analyzed a total of 49 SIB and 28 assault burns out of 1293 total burn patients. Findings revealed that adult SIB, assault burns, and non-intentional burns in our region primarily affects white middle-aged men, but minority ethnic groups were afflicted at a higher rate in the intentional burn groups. The difference between the non-intentional and SIB group was significant for some burn severity and outcome variables: total TBSA, second-degree burn, third-degree burn, length of stay, facial burn, inhalation injury and mortality when not compared with other variables. total TBSA, second-degree TBSA, third-degree TBSA and inhalation injury were found to be associated with intentionality, but neither of the outcome variables were found to be correlated when analyzed with other variables. The following past medical history and history of present illness correlated as well: history of mental illness, history of drug abuse, history of self-harm, history of mental hospitalization, history of self-harm hospitalization, history of abuse, history of burn hospitalization, and burn symmetry. The probability of SIB was well modeled by a function of total TBSA and presence of a history of drug abuse. An analysis of psychiatric ailments revealed that patients with certain medical conditions had significantly higher odds of having committed a self-inflicted burn injury - depression was 9 times more likely, acute schizophrenia was 10 times more likely, and borderline personality disorder was 25 times more likely. Most self-inflicted burns were suicide attempts (67%) with the most common known etiology being gasoline (35%) and most common prior life event was a dispute with another person (27%). While self-inflicted burns constitute a small number of patients in the hospital, the proportional mortality is greater due to the frequency of SIB patients with larger burn injury. Our findings demonstrate that while LOS and mortality occur at a higher rate, that these variables are not indicators of SIB. As burn care continues to improve, the steps to decrease morbidity and mortality of burn care may need to shift to preventative measures and collaboration with municipal districts to identify and diffuse high-risk patients prior to an SIB occurring.