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

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.

Self-inflicted burns in Brazil: systematic review and meta-analysis / Queimaduras autoprovocadas no Brasil: revisão sistemática e meta-análise

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.

RESUMO Introdução: Queimaduras representam um componente fundamental do trauma no Brasil, sendo responsáveis por 2 milhões de incidentes e 2.500 mortes anualmente. Queimaduras autointencionais estão associadas a pior prognóstico, maior superfície corporal queimada, maiores taxas de infecção e morte. A falta de estudos sobre a problemática da autoimolação levanta questões epidemiológicas em relação às vítimas brasileiras. O estudo se objetivou investigar o perfil das queimaduras associados ao comportamento autolesivo entre vítimas brasileiras. Métodos: Esta revisão sistemática foi realizada de acordo com as diretrizes PRISMA 2020 e avaliou a correlação entre comportamento autolesivo como causa de queimaduras em vítimas brasileiras e suas implicações epidemiológicas nos últimos 20 anos (2003-2023). Os termos MeSH "Burns", "Self-Injurious Behavior", "Epidemiology" e "Brazil" foram elencados no PubMed/MEDLINE, SciELO e Cochrane Library e, após seleção por critérios de inclusão/exclusão, os estudos mais relevantes foram analisados criticamente. Resultados: Dos 1.077 estudos pré-selecionados, 92 foram potencialmente elegíveis, resultando em 7 manuscritos incorporados nesta revisão. Das 3.510 vítimas queimadas reunidas no conjunto de estudos selecionados, 311 casos apresentaram comportamento autolesivo. Pacientes que tentaram autoimolação apresentam maior risco de morte (p<0,05; RR=5,1 [3,2-8,1]) e maior superfície corporal queimada (p<0,05; MD=19,2 [10-28,2]), em comparação com casos acidentais. Ademais, o sexo feminino apresentou maior risco para tentativa de autoimolação (p<0,05; RR=4,01 [2,9-5,5]). Conclusão: Nossos resultados mostram que os casos de queimaduras autoprovocadas foram associados a uma maior área de superfície corporal queimada e a um maior risco de morte, e o sexo feminino foi identificado como um fator de risco relevante no Brasil.