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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2018

Open Access 01-12-2018 | Original research

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

Authors: Jochen Gille, Thomas Schmidt, Adrian Dragu, Dimitri Emich, Peter Hilbert-Carius, Thomas Kremer, Thomas Raff, Beate Reichelt, Apostolos Siafliakis, Frank Siemers, Michael Steen, Manuel F. Struck

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2018

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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.
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Metadata
Title
Electrical injury – a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors
Authors
Jochen Gille
Thomas Schmidt
Adrian Dragu
Dimitri Emich
Peter Hilbert-Carius
Thomas Kremer
Thomas Raff
Beate Reichelt
Apostolos Siafliakis
Frank Siemers
Michael Steen
Manuel F. Struck
Publication date
01-12-2018
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-018-0513-2

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