Abstract
BackgroundElectrical injuries represent life-threatening emergencies. Evidence on differences between high (HVI) and low voltage injuries (LVI) regarding characteristics at presentation, rhabdomyolysis markers, surgical and intensive burn care and outcomes is scarce.MethodsConsecutive patients admitted to two burn centers for electrical injuries over an 18-year period (1998–2015) were evaluated. Analysis included comparisons of HVI vs. LVI regarding demographic data, diagnostic and treatment specific variables, particularly serum creatinine kinase (CK) and myoglobin levels over the course of 4 post injury days (PID), and outcomes.ResultsOf 4075 patients, 162 patients (3.9%) with electrical injury were analyzed. A total of 82 patients (50.6%) were observed with HVI. These patients were younger, had considerably higher morbidity and mortality, and required more extensive burn surgery and more complex burn intensive care than patients with LVI. Admission CK and myoglobin levels correlated significantly with HVI, burn size, ventilator days, surgical interventions, amputation, flap surgery, renal replacement therapy, sepsis, and mortality. The highest serum levels were observed at PID 1 (myoglobin) and PID 2 (CK). In 23 patients (14.2%), cardiac arrhythmias were observed; only 4 of these arrhythmias occurred after hospital admission. The independent predictors of mortality were ventilator days (OR 1.27, 95% CI 1.06–1.51, p = 0.009), number of surgical interventions (OR 0.47, 95% CI 0.27–0.834, p = 0.010) and limb amputations (OR 14.26, 95% CI 1.26–162.1, p = 0.032).ConclusionsPatients with electrical injuries, HVI in particular, are at high risk for severe complications. Due to the need for highly specialized surgery and intensive care, treatment should be reserved to burn units. Serum myoglobin and CK levels reflect the severity of injury and may predict a more complex clinical course. Routine cardiac monitoring > 24 h post injury does not seem to be necessary.
Highlights
Cardiac arrhythmia was observed in 23 patients (14.2%), including seven patients who required cardiopulmonary resuscitation (CPR) at the scene of whom five survived until burn intensive care unit (BICU) discharge to rehabilitation (Table 1)
The results of our study show that patients suffering from High voltage injury (HVI) show significantly higher morbidity and mortality rates than low voltage victims
Our data consistently confirm the results of previous studies supporting the need for specialized burn intensive care after electrical injury
Summary
Evidence on differences between high (HVI) and low voltage injuries (LVI) regarding characteristics at presentation, rhabdomyolysis markers, surgical and intensive burn care and outcomes is scarce. Electrical injuries are rare but potentially life-threatening emergencies. Voltage exposure is defined by industrial norms as either above or below 1000 V (high voltage injuries (HVI) or low voltage injuries (LVI), respectively) [1]. Gille et al Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2018) 26:43 often require repetitive surgery. The goal of this study was to explore differences in prehospital care, admission characteristics, burn intensive care, surgery and outcomes in patients requiring admission to a burn intensive care unit (BICU) after HVI and LVI
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