Bebbington Emily, Ramesh Parvathy, McPhillips Rebecca, Bibi Fatima, Khan Murad, Kakola Mohan, Poole Rob, Robinson Catherine
Centre for Mental Health and Society, School of Health Sciences, Bangor University, LL13 7YP, UK.
Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK.
Burns. 2024 Mar;50(2):302-314. doi: 10.1016/j.burns.2023.10.008. Epub 2023 Oct 31.
A key component in the classification of all injury types is to differentiate whether the injury was deliberately inflicted and by whom, commonly known as "intent" in the surveillance literature. These data guide patient care and inform surveillance strategies. South Asia is believed to have the greatest number of intentional burn injuries, but national surveillance data is not disaggregated by injury intent. Scientific literature can be used for injury surveillance where national data collection does not exist. In order to synthesise research findings, it is essential to assess the potential impact of misclassification bias. We therefore conducted a systematic scoping review to understand terminology and methods used to differentiate injury intent of hospital burn patients in South Asia.
We followed the methods in our registered protocol (https://doi.org/10.17605/OSF.IO/DCYNQ). Studies met defined population, concept, context, and study design criteria. The databases Embase, MEDLINE, CINAHL, PsycInfo, and PakMediNet were searched. Two reviewers independently screened results. Data were extracted in a standardised manner and verified. The rigour of the method used to differentiate injury intent was appraised.
1435 articles were screened. Of these, 89 met our inclusion criteria. Most articles were from India and Pakistan, and used an observational study design. There were 14 stem terms used in the articles. The most common was "cause". There were 40 classifier terms. The most common were "accident", "suicide", and "homicide". Few articles defined these terms. The method used to differentiate injury intent was only described explicitly in 17% of articles and the rigour of the methods used were low. Where methods of differentiation were described, they appear to be based on patient or family report rather than multidisciplinary assessment.
The heterogeneity in terms, lack of definitions, and limited investigation of injury intent means this variable is likely to be prone to misclassification bias. We strongly recommend that the global burn community unites to develop a common data element, including definitions and methods of assessment, for the concept of burn injury intent to enable more reliable data collection practices and interstudy comparisons.
对所有损伤类型进行分类的一个关键要素是区分损伤是否为故意造成以及由谁造成，这在监测文献中通常被称为“意图”。这些数据指导患者护理并为监测策略提供信息。据信南亚故意烧伤的人数最多，但国家监测数据并未按损伤意图进行分类。在不存在国家数据收集的情况下，科学文献可用于损伤监测。为了综合研究结果，评估错误分类偏差的潜在影响至关重要。因此，我们进行了一项系统的范围综述，以了解用于区分南亚医院烧伤患者损伤意图的术语和方法。
共筛选了1435篇文章。其中，89篇符合我们的纳入标准。大多数文章来自印度和巴基斯坦，采用观察性研究设计。文章中使用了14个主干术语。最常见的是“原因”。有40个分类术语。最常见的是“事故”“自杀”和“他杀”。很少有文章对这些术语进行定义。用于区分损伤意图的方法仅在17%的文章中明确描述，且所使用方法的严谨性较低。在描述区分方法的地方，它们似乎基于患者或家属报告而非多学科评估。
术语的异质性、缺乏定义以及对损伤意图的有限调查意味着这个变量可能容易出现错误分类偏差。我们强烈建议全球烧伤界联合起来，为烧伤损伤意图这一概念制定一个通用的数据元素，包括定义和评估方法，以实现更可靠的数据收集实践和研究间比较。
