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. 2018 May 31;26(1):43.
doi: 10.1186/s13049-018-0513-2.

Electrical injury - a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors

Jochen Gille  1 , Thomas Schmidt  2 , Adrian Dragu  3   4 , Dimitri Emich  1 , Peter Hilbert-Carius  5 , Thomas Kremer  3 , Thomas Raff  3 , Beate Reichelt  6 , Apostolos Siafliakis  6 , Frank Siemers  6 , Michael Steen  6 , Manuel F Struck  7   8
Affiliations

Electrical injury - a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors

Jochen Gille et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Electrical 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.

Methods: Consecutive 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.

Results: Of 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).

Conclusions: Patients 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.

Keywords: Amputation; Burns; Creatinine kinase; Electrical injury; High voltage; Myoglobin.

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Conflict of interest statement

Ethics approval and consent to participate

The need for ethical approval was waived by the Ethical Review Board of the Medical Association of Saxony-Anhalt, Halle, Germany, (project ID 75/17) and by the Ethical Review Board of the Medical Association of Saxony, Dresden, Germany (project ID EK-BR-15/12–1). Consent to participate was not applicable due to the retrospective nature of the study.

Consent for publication

The need for informed consent was waived by the Ethical Review Boards of both study centers.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Boxplots of serum myoglobin values of high voltage injury patients. In the boxes, the dark horizontal line represents the median, with the box representing the 25th and 75th percentiles, the whiskers the 5th and 95th percentiles, the circles the outliers, and extreme outliers (three times the height of the boxes) represented by asterisks
Fig. 3
Fig. 3
Boxplots of serum creatine kinase values of high voltage injury patients. In the boxes, the dark horizontal line represents the median, with the box representing the 25th and 75th percentiles, the whiskers the 5th and 95th percentiles, the circles the outliers, and extreme outliers (three times the height of the boxes) represented by asterisks
See this image and copyright information in PMC

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