Elsevier

Burns

Volume 38, Issue 5, August 2012, Pages 630-637
Burns

Review
Epidemiology of burns throughout the World. Part II: Intentional burns in adults

https://doi.org/10.1016/j.burns.2011.12.028Get rights and content

Abstract

A significant number of burns and deaths from fire are intentionally wrought. Rates of intentional burns are unevenly distributed throughout the world; India has a particularly high rate in young women whereas in Europe rates are higher in men in mid-life. Data from hospitalized burn patients worldwide reveal incidence rates for assault by fire and scalds ranging from 3% to 10%. The average proportion of the body surface area burned in an assault by fire or scalds is approximately 20%. In different parts of the world, attempted burning of others or oneself can be attributed to different motives. Circumstances under which assaults occur fall largely into the categories of interpersonal conflict, including spousal abuse, elder abuse, or interactions over contentious business transactions. Contributing social factors to assaults by burning include drug and alcohol abuse, non-constructive use of leisure time, non-participation in religious and community activities, unstable relationships, and extramarital affairs. Although the incidence of self-mutilation and suicide attempts by burning are relatively low, deliberate self-harm carries a significant risk of death, with an overall mortality rate of 65% worldwide. In those who resort to self-immolation, circumstantial themes reflect domestic discord, family dysfunction, and the social ramifications of unemployment. Preventing injurious burn-related violence requires a multifaceted approach, including legislation and enforcement, education, and advocacy. Better standardized assessment tools are needed to screen for risks of abuse and for psychiatric disorders in perpetrators.

Introduction

Intentional burns are those in which the act that led to the injury has the purpose of causing harm. The immediate aim of the assailant is to use chemicals or thermal energy to inflict damage, resulting in pain, scarring and occasionally death. This review article will discuss the cause of burns stemming from interpersonal violence (assaults, spouse abuse, and elder abuse) as well as self-inflicted violence (suicide, suicide attempts, and self-mutilation). Child abuse by burning has been covered elsewhere [1].

Section snippets

Epidemiology

This article summarizes the available data, gathered from hospital-based studies from low- and high-income countries in regard to intentional injury. Although data reflect a preponderance of first world experience, I have attempted to use sources of information from around the world as much as possible. Further information and data regarding the more general incidence and epidemiology of burns and deaths from fires are available in Part I of this series (Burns 37 (2011), 1087–1100).

The vast

Chemical attacks

Although scald burns by women against men are most often the result an impetuous act prompted by a flare of temper during a quarrel, chemical assaults are often premeditated. Chemical assaults are less common than scalds but they are much more devastating because of the depth and extent of injuries they incur. A review at Prince of Wales Hospital covering the period 1991 through 2001 showed that less than 1% (19/2319) of admissions were for chemical assaults. However, this percentage represents

Elder abuse

It is suspected that elder abuse in general often goes unreported, and elder abuse by burning is probably no exception [33]. Of 28 patients aged 60 years or older who were admitted to the US Army Institute of Surgical Research in 1996, three had been neglected (11%) and one (4%) had been abused. The neglected elders had a mean burn size of 72% and all three died [34]. In another series from the District of Columbia, 10% of burned-and-battered adults were nursing home abuse victims [9].

At

Self-inflicted violence

Suicide from all causes occurs in the US at an annual rate of almost 12 per 100,000, or approximately 94 deaths per day [36]. However, in 2007 the number of suicides by fire and flames in the US (157) was very small compared to those by poisoning (6358) or firearms (17,352) [37]. Moreover, in the same year, non-fatal self-harm by fire or burns was committed by 1591 people, compared to 197,733 by poisoning and 77,024 by cutting and piercing [38]. Nonetheless, deliberate self-harm by burning

Acknowledgements

The author would like to acknowledge the review and insightful commentary by Drs. Andrew Burd (Hong Kong), Shobha Chamania (Indore), and Rajeev Ahuja (New Delhi). As well, he would like to express his appreciation for the editorial skills of Ms. Andrea Sattinger.

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