International Multi-Center Analysis of In-hospital Morbidity and Mortality of Low-Voltage Electrical Injuries.

Alexandra-Maria Warenits,Andreas A Kammerlander,Anton Laggner,Martin Aman,Klaus F Schrögendorfer,Felix Klimitz,Anna Sophie Bergmeister-Berghoff,Konstantin D Bergmeister,Johannes Horter,Ulrich Kneser,Clara Zanon

doi:10.3389/fmed.2020.590758

Abstract

Background : Patients with high- and low-voltage electrical injuries differ in their clinical presentation from minor symptoms to life-threatening conditions. For an adequate diagnosis and treatment strategy a multidisciplinary team is often needed, due to the heterogeneity of the clinical presentation. To minimize costs and medical resources, especially for patients with mild symptoms presenting after low-voltage electrical injuries, risk stratification for the development of further complications is needed.Methods : During 2012–2019 two independent patient cohorts admitted with electrical injuries in two maximum care university hospitals in Germany and Austria were investigated to quantify risk factors for prolonged treatment, the need of surgery and death in low-voltage injuries. High-voltage injuries were used as reference in the analysis of the low-voltage electrical injury.Results : We analyzed 239 admitted patients with low-voltage (75%; 276 ± 118 V), high-voltage (17%; 12.385 ± 28.896 V) or unclear voltage (8%). Overall mortality was 2% (N = 5) associated only with high-voltage injuries. Patients with low-voltage injuries presented with electrocution entry marks (63%), various neurological symptoms (31%), burn injuries (at least second degree) (23%), pain (27%), and cardiac symptoms (9%) including self-limiting thoracic pain and dysrhythmia without any therapeutic need. Seventy three percentage of patients with low-voltage injury were discharged within 24 h. The remaining patients stayed in the hospital (11 ± 10 days) for treatment of entry marks and burns, with an overall need for surgery of 12% in all low-voltage injuries.Conclusions : The only identified risk factors for prolonged hospital stay in patients with low-voltage electrical injuries were the treatment of burns and electric marks. In this multi-center analysis of hospitalized patients, low-voltage electrical injuries were not associated with cardiac arrhythmia or mortality. Therefore, we suggest that asymptomatic patients, without preexisting conditions, with low-voltage injury can be discharged after an initial check-up without prolonged monitoring.

Highlights

Electrical injuries occur frequently, with a broad range of symptoms and may lead to life-threatening secondary complications in certain risk constellations or high-risk patients [1, 2]
We investigate low-voltage injuries and use high-voltage injuries as a reference to quantify risk factors for death, prolonged treatment and need of surgery
All patients treated for low-voltage electrical injuries were included, and high-voltage injuries used as reference

Summary

Introduction

Electrical injuries occur frequently, with a broad range of symptoms and may lead to life-threatening secondary complications in certain risk constellations or high-risk patients [1, 2]. Most electrical injuries result from low-voltage current of 100– 240 V, which is standard household electricity [5,6,7,8]. Often, these patients present with no or mild symptoms, yet some are thought to be at risk for cardiac arrhythmia due to anecdotal reports of sudden cardiac death after electricity [4]. Patients with high- and low-voltage electrical injuries differ in their clinical presentation from minor symptoms to life-threatening conditions. To minimize costs and medical resources, especially for patients with mild symptoms presenting after low-voltage electrical injuries, risk stratification for the development of further complications is needed

Methods

Results

Discussion

Conclusion