Postdischarge Cause-of-Death Analysis of Combat-Related Burn Patients

Abstract

Combat operations in Iraq and Afghanistan have resulted in up to 8.8% of combat-related casualties suffering burns. From World War I through Desert Storm, burns have been associated with approximately 4% of the combat-related deaths. Experiencing a blast injury and exposure to killing and death while deployed has been shown to increase suicide risk. Although several studies of military populations have investigated risk factors for death among burn patients during the acute phase, no studies have reported mortality rates, cause-of-death, or the prevalence of suicide after hospital discharge. This study examined the case fatality rate, causes of death, and the prevalence of suicide among 830 combat burn patients discharged from the sole burn center in the U.S. Department of Defense, between March 7, 2003 and March 6, 2013. Cause-of-death was determined through the Armed Forces Medical Examiner’s Office and the Office of the Secretary of Defense’s National Death Index. A total of 11 deaths occurred among the 830 burn survivors, for an overall case fatality rate of 1.3%. Of the 11 who died, five deaths were related to accidental poisoning by exposure to drugs; three were related to operations of war (two after returning to the war zone), and the remaining three died from other accidental causes (one explosion and two vehicle crashes). There was no indication of suicide or suspicion of suicide as a cause-of-death for the former patients included in this study, suggesting that combat burn injury did not appear to increase the risk of death by suicide in our study population. Further research is needed to understand the factors that contribute to the apparent resilience of combat burn survivors.

Increased Rate of Long-term Mortality Among Burn Survivors

“…This is in stark contrast to the findings of a recent study of combat burn survivors in the United States, in which zero suicide deaths were observed after discharge. 28 While their findings might be related to misclassification bias, differences in suicide risk between civilian and military burn survivors might be related to several factors, including variation in the availability and provision of mental health supports to military personnel compared with civilians, and a pre-existing network of peer support within the military that might help to mitigate psychological stress. Characterization of the differences in health service delivery and resilience traits between military and civilian burn survivors might identify future targets for reducing self-harm and suicide risk among all burn survivors.…”

Outcome of burn care : the mortality perspective

“…Mortality after discharge is low in both children with massive burns followed up for 15 years, and in military personnel followed up for 10 years after combat-related burns (5% and 1.3%, respectively), and the few deaths are rarely related to the burn. 94,95 Although the results are interesting the low generalisability makes it doubtful whether these results can be used for predictions among people with burns generally, as the conclusions were generated by two highly-specific subgroups.…”