• Sandra M Escolas, Debra J Archuleta, Jean A Orman, Kevin K Chung, and Evan M Renz.
• From the *US Army Medical Research Directorate-West, Joint Base Lewis-McChord, Washington; †Clinical Trials and Burn Trauma Task Area; ‡Department of Statistics and Epidemiology, and §ISR Burn Unit, US Army Institute of Surgical Research, Fort Sam Houston, Texas; and ¶Brooke Army Medical Center, Fort Sam Houston, Texas.
• J Burn Care Res. 2017 Jan 1; 38 (1): e158-e164.

AbstractCombat 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.

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