Dr Hardip Chahal1, Dr Derek Liang1, Dr Antony Henderson1, Dr Aruna Wijewardena1, Dr John Vandervord1
1Royal North Shore Hospital, St Leonards, Australia
Self-inflicted burns are commonly admitted to burns units worldwide. These patients are often challenging to manage due to underlying psychosocial issues and multiple representations. The majority of these patients have an underlying psychiatric condition and require multi-disciplinary input. A small subset of these patients present to hospital with recurrent self-inflicted burns. The aim of this study was to explore the factors that contribute to self-inflicted burns readmissions and provide suggestions for treatment pathways.
Method: Self-inflicted burns patient data was drawn from a computerised registry at a single tertiary centre. Data analysis between 2004 to 2019 revealed a total 8849 patients managed for acute burns. 193 (2.1%) were identified as self-inflicted burns. Of these patients 15 (0.2%) were identified to have previous self-inflicted burns and their cases were examined retrospectively.
All patients presenting with self-inflicted burns were reviewed by psychiatric services and had an underlying mental health disorder. Of the recurrent self-inflicted burn patients 12 were females and 3 were male. 75 burns were treated amongst this group at a range of 2 to 20 burns per patients. Chemicals were the most frequent method of burning (69%). Average total body surface area (TBSA) for these burns was 1.6% (range 0.1 – 8% TBSA). Patients had varying levels of psychiatric follow up post discharge.
Borderline personality disorder, female gender, history of substance abuse and developmental trauma are common risk factors for representation. A coordinated treatment pathway involving surgical and early psychiatric input with consistent follow-up is essential in managing recurrent self-inflicted burns patients.
Resident medical officer, Royal North Shore Hospital, Plastic and Reconstructive Department