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Mortality risk and length of stay associated with self-inflicted burn injury: Evidence from a national sample of 30,382 adult patients*

Thombs, Brett D. PhD; Bresnick, Melissa G. BS

doi: 10.1097/01.CCM.0000293122.43433.72
Clinical Investigations
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Objective: Existing studies report contradictory findings regarding characteristics and outcomes of patients admitted with self-inflicted burn injuries. The objective of this study was to report demographic and medical characteristics of patients admitted to burn centers with self-inflicted burn injuries and to assess mortality risk and length of stay compared with patients whose injuries were not self-inflicted.

Design: Retrospective, cohort study.

Setting: A total of 70 burn centers from the United States that contributed data to the American Burn Association National Burn Repository.

Patients: A total of 30,382 adult patients (593 with self-inflicted injuries) who were admitted with a thermal injury from 1995 through 2005.

Interventions: None.

Measurements and Main Results: Demographics, comorbidities, burn injury severity variables (total body surface area burned [TBSA], TBSA burned third degree, inhalation injury), hospital mortality, intensive care length of stay, and total hospital length of stay were ascertained. Patients with self-inflicted injuries had larger TBSA burned (32.0% vs. 12.8%, p < .01) and larger third-degree TBSA burned (20.6% vs. 4.9%, p < .01) and were more likely to incur an inhalation injury (37.3% vs. 12.8%, p < .01). Before matching, patients with self-inflicted injuries were at greater risk of mortality (23.6% vs. 6.8%, p < .01) and required longer intensive care (median of 4 days vs. 0 days, p < .01) and total hospital stays (median of 23 days vs. 8 days, p < .01). After propensity score matching on demographic, medical, and burn injury variables, they were not more likely to die of their injuries (23.6% vs. 23.1%, p = .84), did not require longer intensive care stays (4 days vs. 3 days, p = .75), and did not require longer total hospital stays (23 days vs. 18 days, p = .50).

Conclusions: Compared with patients with similar demographic, health, and injury characteristics whose injuries are not self-inflicted, patients with self-inflicted burn injuries are not at greater risk of mortality and do not require longer durations of intensive care or total hospitalization.

From the Department of Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital and McGill University, Montreal, Quebec (BDT); and the Department of Psychiatry and Behavioral Sciences and the Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, MD (MGB).

The authors have not disclosed any potential conflicts of interest.

No outside funding was received for this study.

The National Burn Repository of the American Burn Association is the source of the data contained in this document. The conclusions and opinions derived from National Burn Repository data represent the authors' views and are not necessarily those of the American Burn Association.

For information regarding this article, E-mail: brett.thombs@mcgill.ca

© 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins