Survivors Of Electrical Injury Research Articles

Establishing the base rate of performance invalidity in a clinical electrical injury sample: Implications for neuropsychological test performance

ABSTRACT Objective: The base rate of neuropsychological performance invalidity in electrical injury, a clinically-distinct and frequently compensation-seeking population, is not well established. This study determined the base rate of performance invalidity in a large electrical injury sample, and examined patient characteristics, injury parameters, and neuropsychological test performance based on validity status. Method: This cross-sectional study included data from 101 patients with electrical injury consecutively referred for post-acute neuropsychological evaluation. Eighty-five percent of the sample was compensation-seeking. Multiple performance validity tests (PVTs) were administered as part of standard clinical evaluation. For patients with four or more PVTs, valid performance was operationalized as less than or equal to one PVT failure and invalid performance as two or more failures. Results: Frequency analysis revealed 66% (n = 67) had valid performance while 29% (n = 29) demonstrated probable invalid performance; the remaining 5% (n = 5) had indeterminate validity. No significant differences in demographics or injury parameters emerged between validity groups (0 vs. 1 vs. ≥2 PVT failures). In contrast, the electrical injury group with invalid performance performed significantly worse across tests of processing speed and executive abilities than those with valid performance (ps< .05, ηp 2 = .19-.25). Conclusions: The current study is the first to establish the base rate of neuropsychological performance invalidity in electrical injury survivors using empirical methods and current practice standards. Patient and clinical variables, including compensation-seeking status, did not differ between validity groups; however, neuropsychological test performance did, supporting the need for multi-method, objective performance validity assessment.

Cataract following electric shock - Case report

Ocular trauma is the under-recognized cause of unilateral blindness particularly in developing nations.The growing demand on generated electricity has also led to increase in electricity related occupational trauma. We report a case of bilateral cataract in a 22 years professional electrician. He survived a high voltage electric shock and sustained burn injury on the right side of his head. Ocular examination revealed typical anterior as well as posterior subcapsular cataract in right eye and visually insignificant early anterior subcapsular vacuoles in the left eye. There was a significant difference in lenticular opacification density in between these two eyes. Uneventful phacoemulsification and foldable posterior chamber intraocular lens implantation was performed in the right eye and the sufferer was rehabilitated with normal best corrected visual acuity. The possibility of ocular complications and importance of ocular screening is emphasized in the survivors of electrical injury. The lenticular opacities can be successfully managed with surgery, however the final visual acuity depends on damage to other vital ocular structures. The clinical features, pathogenic mechanism of these opacities and review of the literatures are discussed.

The impact of electrical injuries on long-term outcomes: A Burn Model System National Database study

IntroductionElectrical injuries exhibit significant acute and long-term sequelae. Amputation and neurological deficits are common in electrical injury survivors. There is a paucity of information on the long-term outcomes of this population. Therefore, this study examines the long-term outcomes of electrical injuries by comparing them to fire/flame injuries. MethodsData from the Burn Model System National Database collected between 1996 and 2015 was examined. Demographic and clinical characteristics for adult burn survivors with electrical and fire/flame injuries were compared. Satisfaction With Life Scale (SWLS), Short Form-12 Physical Composite Score (SF-12 PCS), Short Form-12 Mental Composite Score (SF-12 MCS), and employment status were examined at 24 months post-injury. Linear and logistic regression models were used to assess differences in outcome measures between groups, controlling for demographic and clinical variables. ResultsA total of 1147 adult burn survivors (111 with electrical injuries; 1036 with fire/flame injuries) were included in this study. Persons with electrical injuries were more likely to be male and injured at work (p<0.001). SF-12 PCS scores were significantly worse for survivors with electrical injuries at 24 months post-injury than survivors with fire/flame injuries (p<0.01). Those with electrical injuries were nearly half as likely to be employed at 24 months post-injury than those with fire/flame injuries (p=0.002). There were no significant differences in SWLS and SF-12 MCS between groups. ConclusionsAdult survivors with electrical injuries reported worse physical health and were less likely to be employed at 24 months post-injury compared to survivors with fire/flame injuries. A more detailed understanding of return to work barriers and work accommodations is merited for the electrical injury population. Furthermore, the results of this study should inform future resource allocation for the physical health and employment needs of this population.

Long-term consequences of electrical injury: neuropsychological predictors of adjustment

Objective: Electrical injury (EI) produces an assortment of consequences for individuals. Survivors perform poorly on measures of attention and mental speed, memory, and emotional functioning. Moreover, sequelae are not always reported immediately following injury and often increase over the months following injury. It remains unclear whether the observed increase in neuropsychological and emotional symptoms over time is attributable to the delayed physical effects of EI or other factors that arise subsequent to injury, such as difficulty adjusting to post-injury limitations. Method: The current study utilized archival data to compare the neuropsychological and emotional complaints of EI survivors at two points during recovery, hypothesizing that Time 1 data would predict participants’ outcome at Time 2. Specifically, those with worse neuropsychological performance and greater depressive symptomatology at Time 1 would have worse long-term adjustment to injury and psychological symptomatology. Results: Multiple regression analyses revealed a significant predictive effect of Time 1 neurocognitive performance and depressive symptomatology on Time 2 adjustment to injury, psychological distress, and return to work. Participants with greater depressive symptomatology endorsed during the initial neuropsychological evaluation had substantially more difficulty with overall psychosocial adjustment to electrical injury. Moreover, depressive symptomatology persisted or worsened over the course of recovery. Conclusions: Findings demonstrate that poor outcome 4 years after EI is largely predicated by early emotional sequelae. Early screening and specialized interventions are needed to address psychological symptomatology among EI survivors.

Impact of Posttraumatic Stress Disorder and Depression on Neuropsychological Functioning in Electrical Injury Survivors

To examine neuropsychological functioning in survivors of electrical injury with posttraumatic stress disorder (PTSD) and depression. This was a prospective research study that was done in an outpatient clinic of a rehabilitation hospital. Thirty participants were recruited for the study between January 2008 and December 2010. All participants completed questionnaires measuring depression, PTSD, and a series of standardized psychometric measures of neuropsychological functioning. Domains tested included verbal and visual memory, attention, and executive functioning. A correlation analysis was performed to explore association between variables. Based on the level of PTSD symptoms, subjects were divided into three groups: no PTSD, subclinical PTSD, and PTSD, and a series of one-way analyses of variance were done to explore this association further. A series of analyses of covariance were done to control for depression. PTSD had a significant (P < .05) negative association with immediate verbal memory and immediate and delayed visual memory. Subjects with PTSD had significantly (P < .05) worse scores on immediate and delayed verbal memory and visual memory than those with subclinical PTSD or no PTSD. Measures of attention, working memory, and executive functioning were not significantly different between PTSD groups. When depression was introduced as a covariate, verbal and visual memory scores were not significantly different between PTSD groups. The findings suggest that there is a negative association between PTSD and cognitive performance that may be related to depression among those with electrical injury. A larger sample size is warranted to explore this further.

Echocardiographic Observations in Survivors of Acute Electrical Injury

This report describes for the first time (to our knowledge) persistent left ventricular dysfunction in survivors of electrical injury. Two young men who were resuscitated following electrocution by high tension wires underwent echocardiographic examination after injury. Early studies demonstrated wall motion abnormalities with no to only partial recovery on follow-up. In contrast to a previous report of totally reversible left ventricular dysfunction in a similar setting, these cases suggest that the degree of permanent dysfunction following electrical injury is variable.