Roadblocks to return to work after electrical trauma

Abstract

Electrical trauma in the US is the fifth leading cause of death on the job [2]; during 1992–1998, data show 2,268 fatal electrical injuries [13]. In the same period, 32,309 non-fatal lost time electrical injuries were recorded by the US Bureau of Labor Statistics [9]. The complexity in patients’ clinical presentation reflects the fundamental nature of electrical injury events: these are typically high speed, multi hazard incidents [10– 12]. The clinical spectrum of electrical injury ranges from the absence of any external physical signs to severe multiple trauma requiring extensive surgical care [4,8]. Peripheral nerve disorders as described by Wilbourn [16] can complicate rehabilitation, in addition to traumatic sequella. Research suggests electrical trauma survival can be associated with significant functional impairment. In their landmark retrospective study of employees of a national electrical energy company, Gourbiere et al. reviewed the electrical trauma survival experience during 1970–1989 for a workforce between 100,000–120,000. Electrical burns affected 2080 workers. Of these, 515 patients or 25% were noted to have post-injury complications, including: 63% burn related, with amputations in 5%; 18% neuropsychiatric; 12% sensory; 5% orthopedic; and 1% cardiovascular. Sense organ disorders included vision related changes due to conjunctivitis, keratitis, and cataracts; auditory sequella, with conductive or sensorineural hearing loss, tinnitus, and vertigo; and anosmia. In 59 of the 515 patients, disability was considered serious, with impairment rating from 31–100% [7]. Return to work success of electrical trauma patients is variable, as suggested in the report by Pliskin et al. [14]. In this series study, all patients had peripheral electrical contacts, with no evidence on history or examination of direct mechanical electrical contact with the head. (Facial injuries from electrical arc flash burns were not a basis for excluding a patient for this series study. However, two patients were excluded: one patient was excluded based on his report of repeated stray voltage exposure which could not be verified. A second patient was excluded because of a high suspicion of malingering.) A total 45 males and 8 females were included in the final analysis. These individuals had a mean age of 38.5 years (+ 11.0; 22 to 70) and a mean educational level of 13.1 years (+1.9; 8–18). Twentyone of the 53 patients were injured by voltage sources less than 1000 V (39.6%) and 27 patients sustained voltage exposures greater than 1000 V (50.9%). Fortyfour patients were hospitalized for observation or to receive initial treatment for their injuries (83.0%), while 9 patients were released after initial evaluation. Twenty patients underwent surgery for their injuries (37.7%), 32 patients received either non-surgical treatment or no treatment, and the treatment history for 1 patient was unknown. Sixteen of the 53 patients sustained a loss of consciousness as a result of their electrical accident (30.2%) and 4 patients experienced cardiac arrest (7.5%). Twenty of the 53 patients were employed as electricians or line operators at the time of injury.