Self-inflicted burns in Brazil: systematic review and meta-analysis

NASCIMENTO, JOÃO HENRIQUE FONSECA DO; SOUZA FILHO, BENJAMIM MESSIAS DE; TOMAZ, SELTON CAVALCANTE; VIEIRA, ADRIANO TITO SOUZA; SILVA NETO, MARINHO MARQUES DA; ANDRADE, ANDRÉ BOUZAS DE; SANTANA, DIOGO RADOMILLE DE; GUSMÃO-CUNHA, ANDRÉ

doi:10.1590/0100-6991e-20243665-en

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Review Article • Rev. Col. Bras. Cir. 51 • 2024 • https://doi.org/10.1590/0100-6991e-20243665-en copy

Self-inflicted burns in Brazil: systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

burns represent a pivotal component of trauma in Brazil, accounting for 2 million incidents and 2,500 deaths annually. Self-intentional burns are associated with a worse prognosis, larger burned surface area, higher infection rates, and death. The lack of studies on the issue of self-immolation raises epidemiological questions regarding Brazilian victims. This study aimed to investigate the profile of burn events associated with self-injurious behavior among Brazilian victims.

Methods:

this systematic review was performed according to PRISMA 2020 guidelines and evaluated the correlation between self-injurious behavior as a cause of burns in Brazilian victims and its epidemiological implications in the last 20 years (2003-2023). The MeSH terms “Burns”, “Self-Injurious Behavior”, “Epidemiology” and “Brazil” were queried in the PubMed/MEDLINE, SciELO, and Cochrane Library databases, and, after selection by inclusion/exclusion criteria, the most relevant studies were critically analyzed.

Results:

From 1,077 pre-selected studies, 92 were potentially eligible, resulting in 7 manuscripts incorporated in this review. From 3,510 burned victims assembled in the pool of selected studies, 311 cases displayed self-injurious behavior. Burned patients who attempted to burn their lives have a higher risk of death (p<0.05; RR=5.1 [3.2-8.1]) and larger burned surface area (p<0.05; MD=19.2 [10-28.2]), compared to accidental cases. Moreover, the female gender was at a higher risk of attempting self-immolation (p<0.05; RR=4.01 [2.9-5.5]).

Conclusion:

our results show that self-inflicted burn cases were associated with a larger burned surface area and a higher risk of death, and the female gender was identified as a relevant risk factor in Brazil.

Keywords:
Burns; Brazil; Self-Injurious Behavior; Systematic Review; Meta-Analysis

Author	Year	Study design	Study place	Period of study	Total of patients	Number of accidental burns	Number of self-inflicted intentional burns
Macedo et al.²⁴24 de Macedo JLS, Santos JB. Predictive factors of mortality in burn patients. Rev Inst Med Trop Sao Paulo. 2007;49(6):365-70. doi: 10.1590/s0036-46652007000600006. https://doi.org/10.1590/s0036-4665200700...	2007	Longitudinal and prospective	Brasília/DF	2004 - 2005	278	263	15
Macedo et al.¹³13 Macedo JLS, Rosa SC, Gomes E Silva M. Queimaduras autoinfligidas: tentativa de suicídio. Rev Col Bras Cir. 2011;38(6):387-91. doi: 10.1590/S0100-69912011000600004. https://doi.org/10.1590/S0100-6991201100...	2011	Longitudinal and prospective	Brasília/DF	2008 - 2009	278	263	15
Leão et al.²⁵25 Leão CEG, Andrade ES de, Fabrini DS, Oliveira RA de, Machado GLB, Gontijo LC. Epidemiologia das queimaduras no estado de Minas Gerais. Rev Bras Cir Plást. 2011;26(4):573-7. doi: 10.1590/S1983-51752011000400006. https://doi.org/10.1590/S1983-5175201100...	2011	Longitudinal and prospective	Belo Horizonte/MG	2009 - 2010	687	605	82
Campos et al.²⁶26 De Campos EV, Park M, Gomez DS, Ferreira MC, Azevedo LCP. Characterization of critically ill adult burn patients admitted to a Brazilian intensive care unit. Burns. 2014;40(8):1770-9. doi: 10.1016/j.burns.2014.03.022. https://doi.org/10.1016/j.burns.2014.03....	2014	Longitudinal and prospective	São Paulo/SP	2005 - 2010	163	131	32
Queiroz et al.⁴4 Queiroz LFT, Anami EHT, Zampar EF, Tanita MT, Cardoso LTQ, Grion CMC. Epidemiology and outcome analysis of burn patients admitted to an Intensive Care Unit in a University Hospital. Burns. 2016;42(3):655-62. doi: 10.1016/j.burns.2015.08.002. https://doi.org/10.1016/j.burns.2015.08....	2015	Longitudinal and retrospective	Londrina/PR	2010 - 2012	293	236	35
Duarte et al.¹⁰10 Duarte DW, Neumann CR, Weber ES. Intentional injuries and patient survival of burns: A 10-year retrospective cohort in southern Brazil. Burns. 2015;41(2):271-8. doi: 10.1016/j.burns.2014.07.019. https://doi.org/10.1016/j.burns.2014.07....	2015	Longitudinal and retrospective	Porto Alegre/RS	2003 - 2012	1,633	1,519	114
Mireski et al.¹¹11 Mireski R, Talizin TB, Moya PS, Favoreto JPM, Peras PR, Gasparine AVC dos S, et al. Burns caused by attempted suicide and homicide and its association with prognosis. Rev bras queimaduras. 2016;15(2):87-91.	2016	Longitudinal and retrospective	Londrina/PR	2011 - 2013	178	129	19
				Total	3,510	3,146	311

	Was the study’s target population a close representation of the national population in relation to relevant variables?	Was the sampling frame a true or close representation of the target population?	Was some form of random selection used to select the sample, OR was a census undertaken?	Was the likelihood of nonresponse bias minimal?	Were data collected directly from the subjects (as opposed to a proxy)?	Was an acceptable case definition used in the study?	Was the study instrument that measured the parameter of interest shown to have validity and reliability?	Was the same mode of data collection used for all subjects?	Was the length of the shortest prevalence period for the parameter of interest appropriate?	Were the numerator(s) and denominator(s) for the parameter of interest appropriate?	Rate
Macedo et al.²⁴24 de Macedo JLS, Santos JB. Predictive factors of mortality in burn patients. Rev Inst Med Trop Sao Paulo. 2007;49(6):365-70. doi: 10.1590/s0036-46652007000600006. https://doi.org/10.1590/s0036-4665200700...	N	N	N	Y	Y	Y	Y	Y	N	Y	M
Macedo et al.¹³13 Macedo JLS, Rosa SC, Gomes E Silva M. Queimaduras autoinfligidas: tentativa de suicídio. Rev Col Bras Cir. 2011;38(6):387-91. doi: 10.1590/S0100-69912011000600004. https://doi.org/10.1590/S0100-6991201100...	N	N	N	Y	Y	Y	Y	Y	N	Y	M
Leão et al.²⁵25 Leão CEG, Andrade ES de, Fabrini DS, Oliveira RA de, Machado GLB, Gontijo LC. Epidemiologia das queimaduras no estado de Minas Gerais. Rev Bras Cir Plást. 2011;26(4):573-7. doi: 10.1590/S1983-51752011000400006. https://doi.org/10.1590/S1983-5175201100...	N	N	N	Y	Y	Y	Y	Y	N	Y	M
Campos et al.²⁶26 De Campos EV, Park M, Gomez DS, Ferreira MC, Azevedo LCP. Characterization of critically ill adult burn patients admitted to a Brazilian intensive care unit. Burns. 2014;40(8):1770-9. doi: 10.1016/j.burns.2014.03.022. https://doi.org/10.1016/j.burns.2014.03....	N	N	N	Y	Y	Y	Y	Y	Y	Y	M
Queiroz et al.⁴4 Queiroz LFT, Anami EHT, Zampar EF, Tanita MT, Cardoso LTQ, Grion CMC. Epidemiology and outcome analysis of burn patients admitted to an Intensive Care Unit in a University Hospital. Burns. 2016;42(3):655-62. doi: 10.1016/j.burns.2015.08.002. https://doi.org/10.1016/j.burns.2015.08....	N	N	N	Y	N	Y	Y	Y	N	Y	M
Duarte et al.¹⁰10 Duarte DW, Neumann CR, Weber ES. Intentional injuries and patient survival of burns: A 10-year retrospective cohort in southern Brazil. Burns. 2015;41(2):271-8. doi: 10.1016/j.burns.2014.07.019. https://doi.org/10.1016/j.burns.2014.07....	N	N	N	Y	N	Y	Y	Y	Y	Y	M
Mireski et al.¹¹11 Mireski R, Talizin TB, Moya PS, Favoreto JPM, Peras PR, Gasparine AVC dos S, et al. Burns caused by attempted suicide and homicide and its association with prognosis. Rev bras queimaduras. 2016;15(2):87-91.	N	N	N	Y	N	Y	Y	Y	N	Y	M

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Problem	Self-Injurious Behavior AND Brazil
Exposure	Burns
Comparison	Self-injury Intentional Burns OR Accidental Burns
Outcome	Death OR Survival

Search 1	“Burns”, “Queimaduras” (combined by “OR” operator)
Search 2	“Self-Injurious Behavior”, "Self-Injury", “Comportamento Autodestrutivo”, “Autolesão” (combined by “OR” operator)
Search 3	“Epidemiology”, “Epidemiologia” (combined by “OR” operator)
Search 4	“Brazil”, “Brasil” (combined by “OR” operator)
Final Search	Search 1 AND/OR Search 2 AND/OR Search 3 AND/OR Search 4