The burden and characteristics of burn injuries associated with electronic nicotine delivery systems: A systematic review and single-arm meta-analysis.

Abstract

Electronic nicotine delivery systems (ENDS) are increasingly used worldwide, yet device malfunction, particularly lithium-ion battery failure, has emerged as a preventable cause of burn injury. This study aimed to quantitatively synthesize the anatomical distribution, severity, mechanisms, and treatment of burn injuries associated with ENDS use. A systematic search of PubMed, Embase, and Cochrane CENTRAL was conducted from database inception to December 2025 to identify studies reporting on ENDS-related burn injuries. Eligible studies were synthesized using a single-arm random-effects meta-analysis to generate pooled estimates of injury distribution, burn severity, and treatment modalities. 22 studies, comprising 471 patients, were included. Thermal runaway was the dominant mechanism of injury (99.34%; 95% CI [91.8-99.9]). Thigh involvement was the most frequently injured region (76.56%; 95% CI [64.9-85.2]), followed by hand/upper limb (36.2%), groin (20.10%), head and neck (17.6%), and trunk (15.5%). The pooled mean total body surface area affected was 4.17% (95% CI [3.55-4.78]). Burn depth was predominantly partial-thickness (89.1%; 95% CI [61.2-97.7]), followed by mixed-depth (65.2%; 95% CI [32.4-88]) and full-thickness burns (31.8%; 95% CI [23.8-41.0]). Split-thickness skin grafting was required in 39.8% of patients (95% CI [31.4-48.8]), while the remaining cases were managed by other measures. ENDS-related injuries represent a distinct and clinically significant injury pattern characterized by predictable anatomical distribution, frequent deep dermal involvement, and a high rate of operative management. These findings highlight the need for early specialist burn care, improved device safety standards, and targeted prevention strategies to reduce this burden.