820 Transgender Patients with Assault by Burn

Abstract

Abstract Introduction The transgender population is estimated at 25 million worldwide and 1 million in the United States. Transgender individuals or those experiencing gender dysphoria are at a higher risk of intimate partner violence and assault (60%) as well as suicide (40%), with reports of 18 transgender individuals killed this year alone in the United States. Trauma and burn care providers need to be aware of this population’s unique medical and surgical needs. To our knowledge, we describe the first reports of burn injuries in transgender patients. Methods We performed a retrospective review of all transgender or gender dysphoric patients admitted to a regional burn center from 2010 to 2019 with a major burn diagnosis (>20% total body surface area). Patients were identified by International Classification of Disease codes in addition to self-identification at time of admission. We describe the mechanism of injury, circumstances surrounding the incident, hospital course, disposition at discharge, and outcomes in clinic follow up. Results The cohort consisted of two patients who were transgender females (i.e. born biologic male and identified as female), aged 31 and 36. Both patients were homeless and had histories of substance abuse and mental health issues. The burn sizes were 20% and 80% and both were flame injuries. One was injured by her domestic partner. The other was injured in a tent fire from a camping stove. The 20% TBSA patient underwent 3 surgeries and was discharged to medical respite on PBD #55. The 80% TBSA patient underwent 9 surgeries and was discharged to inpatient rehabilitation on PBD #75. Regarding their transgender medical care, neither patient was actively being treated by a medical professional although they both reported taking estrogens. Neither patient had undergone transgender surgery. Hormone therapy was not continued during their hospital stay due to lack of information surrounding prior use and limited knowledge regarding the safety of hormonal therapy during burn treatment. Both patients were initially lost to follow up but subsequently reentered our health care system. Both patients have since been referred to our county transgender clinic and are now actively followed by a transgender provider. Conclusions Transgender patients are at high risk for violence and assault, which includes burn. These patients are more difficult to identify and may have inadequate transgender medical care. Burn providers of all levels should be aware of the unique needs of this population and involve transgender medical providers in the acute and rehabilitative care when feasible. Applicability of Research to Practice Raise public awareness regarding assault by burn in the transgender population.