|Year : 2015 | Volume
| Issue : 1 | Page : 52-55
Self-inflicted burns among Saudi Arabian soldiers
Fatema Alsubhi, Shafiq Alrahman
Department of Plastic Surgery and Burn, Prince Sultan Medical Military City, Riyadh, Saudi Arabia
|Date of Web Publication||11-Dec-2015|
Dr. Fatema Alsubhi
Department of Plastic Surgery and Burn, Prince Sultan Medical Military City, Riyadh
Source of Support: None, Conflict of Interest: None
Background : Self-inflicted burns (SIB) are the most common and frequently occurring medical challenge to Plastic Surgery and Burn Units worldwide. Only a few reports of SIB among soldiers have been published; they may be committed as a coping mechanism to stress, psychiatric illness, or with a malingering/ulterior motive. The aim of this retrospectives study is to determine the cause and characteristic of the SIBs among soldiers treated at Burn Unit of Prince Sultan Military Medical City (PSMMC) during 2008-2014. Materials and Methods: A retrospective assessment was performed on 82 soldiers treated at Burn Unit of PSMMC for self-inflicted burn injuries. The data collected include age, cause of injuries, side of the body affected, affected organs, month and day of burn injury. Results : The majority of SIB was observed among young soldiers age range 20-35 years. The chemical burn was the most common cause of burn injuries. The SIBs mostly occurred between June and September months with a higher frequency of cases occurring in early weekdays. Most of the burns occurred in the feet and hands, left side of body suffered more burns compared to right side of the body. Conclusion : It may be concluded that chemically induced burns were the most frequent cause of SIB in this study. High frequency of SIB occurred in summer months specifically on Sundays and Mondays. Feet, hands, and legs are the most affected organs. The reason of inflicting self-injury is far from clear it may be either to cope up with stress or with an ulterior motive. Further investigation using the larger sample is suggested.
Keywords: Chemical burn, retrospective self-inflicted burns, soldier
|How to cite this article:|
Alsubhi F, Alrahman S. Self-inflicted burns among Saudi Arabian soldiers. Indian J Burns 2015;23:52-5
| Introduction|| |
Burn injuries are among the most painful of all injuries that a human body can suffer. Burns to skin and tissue may be caused by heat, electricity, radiation, or chemicals. Most commonly, burns result from heat exposure including fire, steam, tar, or hot liquids. Chemically induced burns are similar to thermal burns, whereas burns caused by radiation, sunlight, and electricity tend to differ greatly. Burns are the fourth most common type of trauma worldwide, following the accidents, falls, and interpersonal violence. The worldwide incidence of fire-related injuries has been estimated to be 1.1/100,000 populations, with the highest rate in Southeast Asia and the lowest in the Americas. Approximately 90% of burns occur in low to middle-income countries.
Burns can be inflicted accidentally or purposely. Self-inflicted burning (SIB) are relatively common social and medical problems. SIB constitutes one of the most bizarre approaches that continue to plague humanity even today. The diversity of SIB is large among the patient admitted in the burn unit and range of such burn is 0.37-40% of the total burn. , In general, the burden of SIB is disproportionately shared across the globe which predominantly affects the developing nations. In the recent years, developed countries have made considerable progress in lowering burn-related morbidity and mortality through a combination of awareness program and prevention strategies and improvements in the care of people affected by burns. Unfortunately, most of these advances in prevention and care have been incompletely applied in low- and middle-income countries.
Review of literature revealed that published studies on SIBs among soldiers are scarce, inconclusive, and weak in design.  Most studies contained limited contextual information and limited data on the long-term outcomes of survivors of SIB injuries. In this retrospective study, an attempt has been made to determine the nature and characteristics of SIB among soldiers visiting Burn Unit of Prince Sultan Military Medical City (PSMMC), Riyadh.
| Materials and Methods|| |
Retrospective assessment of the male military patients reported at Burn Care Unit of PSMMC during 2008-2014, for burn and related complications, were selected for the study. The patients' details were obtained from electronic data files stored at the Burn Care Unit. All the Patients were referred from different Military Hospital to Burn Care Unit of PSMMC. The patients were treated as an outpatient in the emergency department or as an in-patient at the Burn Care Unit. The demographic data such as age, cause of accident, side of the body got burnt, organ affected, and month and day of the accident were collected from the patients. The data were collected for 82 months (February 2008-November 2014). This study was approved by The Research and Ethical Committee of PSMMC, Riyadh. Statistical analysis included Chi-square test, P < 0.05 were considered as significant.
| Results|| |
A total of 82 male military patients were treated for SIB and burn-related complication at Burn Unit, PSMMC between 2010 and 2015. The majority of patients (78%) were in the age range of 21-35 years including 35% in the range of 26-30 years, 25% in the range of 21-26 years, and 21% in the range of 30-35 years [Figure 1]. Very few cases of burn were recorded under the age of 20 years or over 35 years. Chemical burns due to corrosive agents including acids, bases, oxidizers, and solvents were the most frequent (90% of all cases) cause of SIBs [Table 1] among military men. The chemical burn was followed by 6% cases of scald burn and 4% cases of hot burn [Table 1]. The left foot (21 cases) and right hand (19 cases) were the most affected parts of the body [Table 2]. Summer period had the maximum of cases for SIBs among soldiers with a maximum of 48% of cases reported between June and September [Figure 2]. Sunday and Monday had the maximum of cases (47%) reported for SIBs [Figure 3].
| Discussion|| |
The Burn Unit of PSMMC treated 82 soldiers of SIB over a period of 82 months, which is a small fraction of accidental burns treated in our burn unit. Our survey of the literature showed that SIB are relatively uncommon in Saudi Arabia as compared to other South East Asian and Middle Eastern countries including Iraq, Iran, Pakistan, Sri Lanka, Afghanistan, and India wherein marital and interpersonal conflicts are the leading causes of SIB.  Distinguishing between intentional SIB from accidental burn injury require a detailed history of preceding events, mechanism and thermal agents used as well as the occupational and social background of the patient.  We found silent but strong evidence that suggests that the cases reported in this study were SIB.
Analysis of data showed that majority of the burn (90%) were inflicted by chemical agents which is in contrast to the other reports where scalding with water  and inflammable liquids  were used for causing SIBs. Another noteworthy finding in this study was that 48% of SIB was recorded between summer month of June to August and mostly (47%) in the beginning of the week (Sunday/Monday). These findings resemble the pattern of SIB observed in a recent Israeli study. Gronovich et al.  suggested that higher incidence of SIB during summer vacation period may reflect ulterior motive where soldier would have liked to spend more time with their families and the high incidence of SIB on Sunday/Monday might be with the intention to delay the rejoining the duties or extending the holidays.
The study of the location of burn showed that foot, hand, and legs were involved in 83% of all SIB. There was no overall difference of involvement of right or in the left side of the body [Table 2]. However, the involvement of left foot (67.8%) was significantly higher compared to the involvement of right foot (32.2%). The results are similar to the finding of Gronovich et al. 2013  among Jewish soldiers showing the significantly high involvement of left foot. These investigators suggested that left foot is an easy site to inflict self-injury with minimal aesthetic consequences where the injury marks can be hidden under the soaks and boots. Moreover, burn on foot may cause lesser pain due to relatively fewer sensory nerves in the foot as compared to other parts of the body.
The reasons for committing SIB may be multifactorial including difficulty handling emotions, poor relation with peers and superiors, low confidence and poor performance in functioning duties.  Klonsky (2007)  suggested that self-injury may primarily be a coping mechanism as a manner of dealing with stressful situation individuals may face in professional and personal life. On the other hand, malingering is a well-known phenomenon where a person inflicts self-injury with a motive or purpose including avoiding military duty, extending leave, or gaining other benefits.  Intentional injuries have been frequently reported in a clinical subgroup of a patient who suffers from psychiatric disorder including depressions, schizophrenia, personality disorder, or drug abuse.  However, our survey of case notes showed that these young soldiers were free from psychiatric disorders or drug abuse. Hence, it may be concluded that SIB observed in our study may to some extant be caused as coping mechanism to overcome professional stress or with ulterior motive (malingering) in some cases. However, detailed studies using large sample may provide a better understanding of motive of SIB. Our data had shortcoming as the surface area of the burn injury was not recorded in the case notes. However, as none of our soldier's required surgical treatment for their injuries it may be concluded that these patients sustained relatively minor injuries.
| Conclusion|| |
It may be concluded that chemically induced burns were the most frequent cause of SIB in this study. High frequency of SIB occurred in summer months specifically on Sundays and Mondays. Foot, hand, and legs are the most affected organs. These soldier inflicted self-injury either to cope up with stress or with an ulterior motive need further investigation. The awareness, early detection, and proper management may help in reducing SIB in military personals. The close monitoring of soldier activities and provision of special social and psychological support is strongly suggested.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]