title: Self-inflicted Burns: 10 year review and comparison to national guidelines.
abstract: BACKGROUND
  There is an increasing trend of self-inflicted burns noted in the literature, often seen in patients with complex psychosocial backgrounds. These patients are challenging to manage as the recovery from the acute burn may be compounded by difficult rehabilitation and suboptimal coping strategies. We aimed to review patients presenting to our burns unit with self-inflicted burns, the management strategies and examine the complexities surrounding their management. We assessed patient outcomes with a particular interest in psychosocial support given.
  
  
  METHODS
  A retrospective review of all patients presenting with self-inflicted burns over a 10 year period (2005-2014 inclusive) was conducted. Patients were identified through IBID database coded as either 'self-inflicted' or 'suicidal.' We reviewed patient and burn demographics, the clinical management, psychosocial management and patient outcomes such as wound healing, re-admission rates, and survival.
  
  
  RESULTS
  We identified 118 self-inflicted burns in total. 50/118 (42%) were admitted. 64 (54%) were male and the total body surface burn area ranged from <0.5% to 99% with a median of 14%. 60/118 (51%) had TBSA <10% and 58/118 (49%) had TBSA >10%. 24 (48%) underwent admission to the Burn Intensive Care Unit (BITU). All patients admitted to BITU had TBSA >10%. Of those admitted to BITU 6 were palliative, 18 had full resuscitation and surgical management. Of those 18 patients who had active treatment, 10/18 (56%) died. Mean total length of stay was 31 days, range 1-130 days. 9% of patients sustained injuries whilst being a current inpatient at a psychiatric institution. Of all patients reviewed, 16% (n=19) had a previous history of deliberate self-harm through burns. Of those patients admitted, 98% of were reviewed by the mental health team during their admission with time to psychological review varying depending on fitness for assessment. The overall mean length of stay for all admitted patients who were actively treated but who subsequently died was 53 days. 84% of admitted patients were managed surgically.
  
  
  CONCLUSIONS
  Self-inflicted burns patients would benefit from a more complex pathway of treatment as their management aims to achieve not only physical health but also psychological health. They would benefit from enhanced care to manage the acute burn but also psychiatric support to ensure patients do not re-offend.
authors.affiliation: St Andrew Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom. Electronic address: paul.caine@doctors.org.uk.
authors.forename: P L
authors.initials: PL
authors.lastname: Caine
authors.affiliation: St Andrew Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Tan
authors.affiliation: St Andrew Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Barnes
authors.affiliation: St Andrew Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: Dziewulski
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001830:Body Surface Area; D002053:Burn Units; D002056:Burns / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010359:Patient Readmission; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000628:therapy; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000453:epidemiology; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014945:Wound Healing; D055815:Young Adult
keywords: Multi-disciplinary team; Psychosocial; Self-inflicted