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Chen J, Wang Y. Characteristics and risk factors for electrical burn injuries: a study based on World Health Organization Global Burn Registry. Burns 2024; 50:1116-1121. [PMID: 38402118 DOI: 10.1016/j.burns.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/28/2022] [Accepted: 01/11/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Electrical burn injuries (EBIs) represent an important subset of burn injuries, but the information on them from the global level is limited. We aimed to investigate the characteristics and risk factors for EBIs reported to the World Health Organization Global Burn Registry. METHODS Patients with EBIs and non-EBIs were identified from the registry. Patient demographics, income of the country, setting of the injury occurred, and outcomes were described and compared. Multivariable analysis was performed to identify risk factors associated with the EBIs and their outcomes. RESULTS Of the 9276 patients, 814 (8.8%) were grouped as EBIs. EBIs patients had a median age of 28 years, and they were predominantly males (89.2%). EBIs were more likely to occur in lower-middle- and low-income countries (60.9% versus 43.4%) and in an occupational setting (49.1% versus 6.7%) than the non-EBIs. Older age, male, lower-income, and occupational and public setting were risk factors for EBIs. For EBIs patients, adolescents and young adults, those from low-middle and low-income countries, and those injured by high-voltage electricity were more likely to have more than 15% of the total body surface area. In addition, those from low-middle and low-income countries and those injured by high-voltage electricity were more likely to die. CONCLUSION The characteristics of EBIs are significantly different from that of non-EBIs. To prevent EBIs and avoid unpleasant outcomes, particular attention should be given to adolescent boys and young adult men who are employed in electrical jobs in lower-income countries.
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Affiliation(s)
- Jigang Chen
- Department of burn and plastic surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Yanni Wang
- Department of burn and plastic surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
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An SJ, Kayange L, Davis D, Peiffer S, Gallaher J, Charles A. Predictors of mortality following electrical and lightning injuries in Malawi: A decade of experience. Burns 2024; 50:754-759. [PMID: 37945505 PMCID: PMC10999340 DOI: 10.1016/j.burns.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/31/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Electrical injuries can be devastating, and data is lacking in low-resource settings. We aimed to identify predictors of mortality following electrical and lightning injuries (ELI) in Malawi. METHODS We performed a retrospective observational study of patients presenting with ELI and burn injuries at a tertiary hospital in Malawi from 2011 to 2020. Outcomes were compared and predictors of mortality were modeled. RESULTS A total of 382 ELI and 6371 burn patients were included. The mean ages for ELI and burn groups were 24 ± 14 and 11 ± 14 years, respectively (p < 0.01). Most patients were injured at home (91% in the burn group versus 51% in the ELI group, p < 0.01). The crude mortality rate in the ELI group was 28%, compared to 12% in the burn group (p < 0.01). On multivariate logistic regression, predictors of mortality included ELI (odds ratio [OR] 13.3, 95% confidence interval [CI] 7.2-24.5) and total body surface area burned (OR 1.1, 95% CI 1.1-1.1). Predicted mortality for ELI has increased over time (p = 0.05). CONCLUSIONS ELI confers more than 13 times higher odds of mortality than burn injuries in Malawi, with mortality risk increasing over time. More efforts are needed to prevent electrical hazards and implement timely interventions for patients with ELI.
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Affiliation(s)
- Selena J An
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC 27599, USA
| | - Linda Kayange
- Department of Surgery, Kamuzu Central Hospital, Private Bag 149, Lilongwe, Malawi
| | - Dylane Davis
- University of North Carolina at Chapel Hill, School of Medicine, 1001 Bondurant Hall, CB 9535, Chapel Hill, NC 27599, USA
| | - Sarah Peiffer
- Baylor College of Medicine, 1 Moursund St, Houston, TX 77030, USA
| | - Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC 27599, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC 27599, USA; Department of Surgery, Kamuzu Central Hospital, Private Bag 149, Lilongwe, Malawi.
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Tróchez-Sanchez JP, Garcia-Perdomo HA. Electrical Burn and Associated Factors That Prolong In-patient Stay in a Level Three Burn Unit. J Burn Care Res 2023; 44:1241-1248. [PMID: 36882105 DOI: 10.1093/jbcr/irad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Indexed: 03/09/2023]
Abstract
Electrical trauma is associated with significant morbidity and mortality, which have been reduced by improved medical care, as measured by the length of stay (LOS) as a marker for this population's quality of care. This paper will review the clinical and demographic characteristics, LOS in the hospital, and variables related to patients with electrical burns. A retrospective cohort study was conducted at a specialized burn unit in Southwest Colombia. Five hundred seventy-five electrical burn-related admissions from 2000 to 2016 were reviewed for the LOS and variables including patient-related (age, gender, marital status, education, and occupation), location of the accident (domestic vs labor-related), voltage, direct contact, arc, flash, flame, clinical presentation (burn surface area, depth, single or multiple organ injury, secondary infection, and abnormal labs), and treatment (surgical procedures and intensive care unit [ICU] admission). Univariate and bivariate analysis, with its 95% CI (confidence interval). We also performed a multiple logistic regression. LOS was correlated to males, age greater than 20 years, construction workers, high voltage injuries, severe burns by area and depth, infection, ICU admission, and multiple surgical procedures or extremity amputation. LOS due to electrical injury was observed to be significantly associated with the following variables, carpal tunnel release (OR [odds ratio]= 4.25, 95% CI [confidence interval] 1.70-5.20); amputation (OR = 2.81, 95% CI 1.60-5.10); infection (OR = 2.60, 95% CI 1.30-5.20); site of infection, mainly wound (OR = 1.30, 95% CI 1.10-1.44); associated injury (OR = 1.72, 95% CI 1.00-3.24); work or domestic accident (OR = 1.83, 95% CI 1.00-3.32); aged 20-40 years (OR = 1.41, 95% CI 1.00-2.10); CPK (OR = 1.40, 95% CI 1.00-2.00); and third-degree burns (OR = 1.55, 95% CI 1.00-2.80). Risk factors for LOS secondary to electrical injury should be appropriately addressed. Prevention at high-risk workplaces is imperative. Mitigating the injury with appropriate management of infection and timely surgical interventions play an essential role in the successful treatment of these patients.
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Affiliation(s)
| | - Herney Andres Garcia-Perdomo
- Division of Urology/Urooncology, Department of Surgery, School of Medicine, Universidad del Valle. Cali, Colombia
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Goffeng LO, Skare Ø, Brinchmann BC, Bjørnsen LP, Veiersted KB. Low-voltage electrical accidents, immediate reactions and acute health care associated with self-reported general health 4 years later. Burns 2023; 49:329-343. [PMID: 35610077 DOI: 10.1016/j.burns.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Electricians frequently experience low-voltage electrical accidents. Some such accidents involve long-term negative health consequences. Early identification of victims at risk for long-term injury may improve acute medical treatment and long-term follow-up. This study aimed to determine acute exposure, health effects and treatment associated with general health ≥ 2 years after low-voltage electrical accidents. METHODS In a cross-sectional study, 89 male electricians who had experienced an electrical accident between 1994 and 2001 participated in a 2003 follow-up health examination. They were identified from a registry of low-voltage electrical accidents and included in the study. Based on exposure descriptions in the original accident reports, they were stratified into the following three groups: a current arc accident group (N = 34, mean age 38.8 years [standard deviation, SD = 12.2, range = 21-59]) and two groups with the passage of current through the body, either fixed to the current source ("no-let-go" group; N = 35, mean age 34.0 years [SD = 10.5, range = 21-57]) or not ("let-go" group; N = 20, mean age = 38.7 years [SD = 10.3, range = 21-63]). They retrospectively described acute reactions and assessed their current general health at the health examination. Multivariate linear regression, ordinal logistic regression and Fisher's exact test were used to compare acute reactions with health at follow-up in each exposure group. RESULTS The multivariate analysis indicated that after accidents with the passage of current through the body, severe acute headache (β = - 0.56, p = 0.013), years since the accident (β = - 0.16, p = 0.017) and the accident being perceived as frightening (β = - 0.48, p = 0.040) were negatively associated with general health ≥ 2 years later (R2 = 0.25, p = 0.002). If the exposure included a no-let-go experience, then acute severe body numbness (β = - 0.53, p = 0.029) was also negatively associated with general health (R2 = 0.38, p = 0.002). Without such experience, only acute confusion (β = - 0.90, p = 0.029) was negatively associated with the health at follow-up (R2 = 0.24, p = 0.029). In univariate analyses, after the passage of current through the body, acute dizziness (p = 0.029), apathy (p = 0.028), confusion (p = 0.007) and irregular heartbeat (p ≤ 0.05) were associated with poor long-term general health. The no-let-go group, more often than the let-go group, reported panic (p = 0.001), fear of death (p = 0.029), confusion (p = 0.014), exhaustion (p = 0.009), bodily numbness (p = 0.013) and immediate unconsciousness (p = 0.019). Acute symptoms beyond the first day after a current arc accident were associated with poor long-term general health (p = 0.015). DISCUSSION AND CONCLUSIONS The acute reactions negatively associated with general health ≥ 2 years after low-voltage electrical accidents should alert the clinician in the acute phase after an electrical accident to the risk of developing negative long-term health effects. Future studies should specify long-term health beyond the concept of general health.
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Affiliation(s)
- Lars Ole Goffeng
- Group for Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway.
| | - Øivind Skare
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Bendik C Brinchmann
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway; Department of Environmental Health, Norwegian Institute of Public Health, N-0403 Oslo, Norway
| | - Lars Petter Bjørnsen
- Clinic of Emergency Medicine and Prehospital Care, St. Olav's Hospital-Trondheim University Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kaj Bo Veiersted
- Group for Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
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Wold A, Rådman L, Norman K, Olausson H, Thordstein M. Clinical Evaluation of Nerve Function in Electrical Accident Survivors with Persisting Neurosensory Symptoms. Brain Sci 2022; 12:brainsci12101301. [PMID: 36291235 PMCID: PMC9599311 DOI: 10.3390/brainsci12101301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Work related electrical accidents are prevalent and can cause persisting symptoms. We used clinical neurophysiological techniques to assess neurosensory function following electrical accidents and correlated test results with the patients’ symptoms. Methods: We studied 24 patients who reported persisting neurosensory symptoms following a workplace electrical accident. We assessed nerve function using quantitative sensory testing (QST), thermal roller testing, laser evoked potential (LEP), and electroneurography. The patients’ results were compared with previously established normative data. Results: Altogether, 67% of the patients showed at least one neurosensory impairment with a large heterogeneity in test results across patients. At a group level, we observed significant deviations in in QST, LEP, and sensory and motor neurography. Overall, we found a weak correlation between test results and self-reported symptoms. Conclusions: In a majority of patients with neurosensory symptoms after a workplace electrical accident, neurosensory testing confirmed the existence of an underlying impairment of the nervous system.
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Affiliation(s)
- Andrew Wold
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
- Correspondence:
| | - Lisa Rådman
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
| | - Kerstin Norman
- National Unit for Health and Safety, Swedish Police Authority, 10226 Stockholm, Sweden
| | - Håkan Olausson
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
- Neuro, Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
| | - Magnus Thordstein
- Neuro, Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
- Department of Clinical Neurophysiology, Region Östergötland University Hospital, 58185 Linköping, Sweden
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Epidemiology, Geographical Distribution, and Outcome Analysis of Patients with Electrical Burns Referred To Shiraz Burn Center, Shiraz, Iran during 2008-2019. World J Plast Surg 2022; 11:102-109. [PMID: 36117901 PMCID: PMC9446130 DOI: 10.52547/wjps.11.2.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Burn is one of the most significant injuries in industrial and developing societies and is one of the most important traumas leading to hospitalization. The aim of this study was to identify the epidemiology, geographical distribution, and outcome of electric burns in Fars province and to present the distribution map. Methods: In this descriptive-analytical study, the study population involved all electrical burn victims admitted to Amir al-Momenin and Ghotbeddin Hospitals from 2008 to 2019 in Fars province in the south of Iran. Data were analyzed using SPSS software version 22. Results: Among a total of 246 patients, the average age was 30.78 ± 11.07. The highest frequency among educational levels was among under-diploma patients (38.6%), and the majority were employed (87.4%). Also, most of the patients were from urban areas (70.3%). The majority of burn incidences occurred at the workplace (57.7%). Also, among the high voltage patients, 25 patients (30.9%) had an amputation, while among low voltage only 12 patients (16.2%) had an amputation. Non-surgical treatment was applied in 68 (28%) cases, while Escharotomy was performed in 28 (11.4%) patients. There was also a statistically significant association between burn voltage and amputation (P= 0.039). Conclusion: Based on our report, the rate of electrical burn injuries in Iran is still high, which underlines the need for stronger efforts in effective prevention, such as better public education and the establishment of strict regulations regarding the distribution and use of electricity.
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Biering K, Nielsen KJ, Carstensen O, Kærgaard A. Electricians' Health After Electrical Shocks: A Prospective Cohort Study. J Occup Environ Med 2022; 64:e237-e244. [PMID: 35143452 DOI: 10.1097/jom.0000000000002494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine whether demographic and health factors are associated with risk of electrical shocks and compared mental and physical health before and after an electrical shock. METHODS A 6-month cohort study of 6960 electricians involved weekly questionnaires regarding exposure to electrical shocks, and health. We examined the association between health and demographic factors and the risk of eventual electrical shocks and health before and after a shock. RESULTS Youth and poor health were associated with risk of shocks. Reporting of numbness, cramps/spasms, tremors, tinnitus, dizziness, and flashbacks increased in the week of the shock, but only tinnitus and flashbacks persisted, as other symptoms receded. Severity, high voltage, cross-body exposure, wet entry/exit points, and direct current as well as health worries and/or neuroticism increased some estimates. CONCLUSION Electrical shocks are common, but rarely result in health effects.
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Affiliation(s)
- Karin Biering
- Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Herning, Denmark (Dr Biering, Dr Nielsen, Dr Carstensen, and Dr Kærgaard)
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Nielsen KJ, Carstensen O, Kærgaard A, Vestergaard JM, Biering K. Neurological symptoms and disorders following electrical injury: A register-based matched cohort study. PLoS One 2022; 17:e0264857. [PMID: 35235596 PMCID: PMC8890633 DOI: 10.1371/journal.pone.0264857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/17/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Electric shocks may have neurological consequences for the victims. Although the literature on the neurological consequences of electric shocks is limited by retrospective designs, case studies and studies of selected patient groups, previous research provides some evidence of a link between electric shocks, and diseases and symptoms of the central nervous system (CNS)(e.g. epilepsy, migraine and vertigo) and the peripheral nervous system (PNS)(e.g. loss of sensation, neuropathy and muscle weakness). This study aims to employ a register-based, matched cohort study, to investigate whether individuals demonstrate a greater risk of neurological diseases and symptoms of the CNS or PNS in the years following an electrical injury. Materials and methods We identified 14,112 electrical injuries over a period of 19 years in two Danish registries, and matched these with three different groups of persons in a prospective matched cohort study: (1) patients with dislocation/sprain injuries, (2) patients with eye injuries and (3) persons employed in the same occupation. Year of injury, sex and age were used as matching variables. The outcomes we identified comprised neurological disorders and central or peripheral nervous system symptoms that covered a range of diagnoses in the Danish National Patient Register. The associations were analysed using conditional logistic regression for a range of time periods (six months to five years) and conditional Cox regression for analyses of the complete follow-up period (up to 20 years). Results For victims of electric shock, the CNS sequelae we identified included an increased risk of epilepsy, convulsions, abnormal involuntary movements, headache, migraine and vertigo. We also identified an uncertain, increased risk of spinal muscular atrophy and dystonia, whereas we identified no increased risk of Parkinson’s disease, essential tremor, multiple sclerosis or other degenerative diseases of the nervous system. For victims of electric shock, the PNS sequelae we identified included an increased risk of disturbances of skin sensation, mononeuropathy in the arm or leg and nerve root and plexus disorders. We also identified an uncertain, increased risk of facial nerve disorders, other mononeuropathy, and polyneuropathy. Conclusion Our results confirm that electrical injuries increase the risk of several neurological diseases and symptoms of the CNS or PNS in the years following the injury. Most often the diseases and symptoms are diagnosed within the first six months of the injury, but delayed onset of up to 5 years cannot be ruled out for some symptoms and diagnoses. Some of the conditions were rare in our population, which limited our ability to identify associations, and this warrants cautious interpretation. Therefore, further studies are needed to confirm our findings, as are studies that examine the mechanisms underlying these associations.
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Affiliation(s)
- Kent J. Nielsen
- Department of Occupational Medicine—University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Herning, Denmark
- * E-mail:
| | - Ole Carstensen
- Department of Occupational Medicine—University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Herning, Denmark
| | - Anette Kærgaard
- Department of Occupational Medicine—University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Herning, Denmark
| | - Jesper Medom Vestergaard
- Department of Occupational Medicine—University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Herning, Denmark
| | - Karin Biering
- Department of Occupational Medicine—University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Herning, Denmark
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Poulsen PH, Carstensen O, Kærgaard A, Vestergaard JM, Nielsen KJ, Biering K. Unspecified pain and other soft tissue disorders following electrical injuries: a register-based matched cohort study. Int Arch Occup Environ Health 2021; 95:799-809. [PMID: 34628524 PMCID: PMC9038797 DOI: 10.1007/s00420-021-01802-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/05/2021] [Indexed: 11/25/2022]
Abstract
Objective This study investigates whether individuals who have sustained an electrical injury (EI) are diagnosed with unspecified pain or pain related to the musculoskeletal system in the years following the injury. Methods Individuals listed in Danish registers as having sustained EIs were matched for sex, age, and year of injury in a cohort study with individuals having experienced dislocations/sprains (match 1), eye injuries (match 2), and a sample of individuals with the same occupation without a history of electrical injuries (match 3). Outcomes were unspecified pain and unspecified soft tissue disorders. Conditional logistic regression and conditional Cox regression were applied. Results We identified 14,112 individuals who sustained EIs. A higher risk of both outcomes was observed for all three matches, and was highest at the 6- and 12-month follow-ups. The risk of both outcomes was considerably higher for match 3. Conclusions This study confirms that exposure to EIs increases the risk of being diagnosed with unspecified pain or unspecified soft tissue disorders both at short and long terms. Our results also showed that the risk of unspecified pain as sequelae is related to the severity of the injury.
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Affiliation(s)
- Per Hoegh Poulsen
- Danish Ramazzini Centre, Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, 7400, Herning, Denmark.
| | - Ole Carstensen
- Danish Ramazzini Centre, Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, 7400, Herning, Denmark
| | - Anette Kærgaard
- Danish Ramazzini Centre, Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, 7400, Herning, Denmark
| | - Jesper Medom Vestergaard
- Danish Ramazzini Centre, Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, 7400, Herning, Denmark
| | - Kent J Nielsen
- Danish Ramazzini Centre, Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, 7400, Herning, Denmark
| | - Karin Biering
- Danish Ramazzini Centre, Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, 7400, Herning, Denmark
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López-Jácome LE, Chávez-Heres T, Becerra-Lobato N, García-Hernández MDL, Vanegas-Rodríguez ES, Colin-Castro CA, Hernández-Durán M, Cruz-Arenas E, Cerón-González G, Cervantes-Hernández MI, Ortega-Peña S, Mondragón-Eguiluz JA, Franco-Cendejas R. Microbiology and Infection Profile of Electric Burned Patients in a Referral Burn Hospital in Mexico City. J Burn Care Res 2021; 41:390-397. [PMID: 31711214 DOI: 10.1093/jbcr/irz177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Electrical burn injuries are one of the most severe forms of trauma. This study aims to investigate the infection complications in electrical burn patients in a referral hospital in Mexico City. A longitudinal retrospective study was conducted, involving electrical burn patients admitted from April 2011 to December 2016. Demographic and clinical data including type of electric burns, infection complications, and mortality was sought. Data were collected at admission and daily until discharge. Number and type of infections and microorganism isolations were sought. Risk factors for death were analyzed. A total of 111 patients were included, of which 96.4% were males, mean age of 31.6±16.22, most injuries were high voltage associated. The total body surface area average was 27.8% ± 19.63. The overall infection rate was 72.9 cases per 100 patients. Mortality was observed in 4 (3.6%) patients. About 59.1% (443/749) had growth for Gram-negative bacteria. Multidrug-resistant Pseudomonas aeruginosa was the most frequent microorganism isolated. Fungi were present in 4.9% of cases. Electrical burn injuries occurred in young males in our study. Infection was frequent, most of them caused by Gram-negative rods with an important rate of antimicrobial resistance; however, an important microbial diversity was present.
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Affiliation(s)
- Luis Esaú López-Jácome
- Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilico #289 Col, Arenal de Guadalupe, Alc. Tlalpan, Mexico City, Mexico
| | - Tatiana Chávez-Heres
- Unit of Hospital Epidemiology Surveillance, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilico #289 Col, Arenal de Guadalupe, Alc. Tlalpan, Mexico City, Mexico
| | - Noé Becerra-Lobato
- Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilico #289 Col, Arenal de Guadalupe, Alc. Tlalpan, Mexico City, Mexico
| | - María de Lourdes García-Hernández
- Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilico #289 Col, Arenal de Guadalupe, Alc. Tlalpan, Mexico City, Mexico
| | - Edgar Samuel Vanegas-Rodríguez
- Unit of Hospital Epidemiology Surveillance, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilico #289 Col, Arenal de Guadalupe, Alc. Tlalpan, Mexico City, Mexico
| | - Claudia Adriana Colin-Castro
- Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilico #289 Col, Arenal de Guadalupe, Alc. Tlalpan, Mexico City, Mexico
| | - Melissa Hernández-Durán
- Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilico #289 Col, Arenal de Guadalupe, Alc. Tlalpan, Mexico City, Mexico
| | - Esteban Cruz-Arenas
- Unit of Hospital Epidemiology Surveillance, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilico #289 Col, Arenal de Guadalupe, Alc. Tlalpan, Mexico City, Mexico
| | - Guillermo Cerón-González
- Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilico #289 Col, Arenal de Guadalupe, Alc. Tlalpan, Mexico City, Mexico
| | - Mercedes Isabel Cervantes-Hernández
- Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilico #289 Col, Arenal de Guadalupe, Alc. Tlalpan, Mexico City, Mexico
| | - Silvestre Ortega-Peña
- Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilico #289 Col, Arenal de Guadalupe, Alc. Tlalpan, Mexico City, Mexico
| | - Jaime Arturo Mondragón-Eguiluz
- Unit of Hospital Epidemiology Surveillance, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilico #289 Col, Arenal de Guadalupe, Alc. Tlalpan, Mexico City, Mexico
| | - Rafael Franco-Cendejas
- Infectious Diseases Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilico #289 Col, Arenal de Guadalupe, Alc. Tlalpan, Mexico City, Mexico
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Paxton JL, Resch ZJ, Cation B, Lapitan F, Obolsky MA, Calderone V, Fink JW, Lee RC, Soble JR, Pliskin NH. The relationship between neuropsychological dispersion, processing speed and memory after electrical injury. J Clin Exp Neuropsychol 2021; 43:144-155. [PMID: 33648409 DOI: 10.1080/13803395.2021.1889989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Previous studies of neuropsychological performance in electrical injury (EI) patients have produced evidence of deficits in various cognitive domains, but studies have yet to investigate relationships among performance in cognitive domains post-EI. This study examined whether dispersion among neuropsychological test scores was associated with injury parameters and neuropsychological performance in EI patients. Additionally, we examined whether dispersion, processing speed and/or executive abilities explain variance in episodic verbal and visual memory performance among EI patients.Method: Data from 52 post-acute EI patients undergoing outpatient evaluation with objectively-verified valid neuropsychological test performance were examined. Tests included measures of verbal and visual memory, processing speed, and executive functioning. Dispersion was calculated from executive functioning and processing speed scores.Results: Dispersion was not related to mean performance or injury characteristics, but was significantly negatively correlated with performance on a test of processing speed, suggesting that increased dispersion is associated with reduced cognitive efficiency post-EI. Delayed visual memory was related to both dispersion scores and processing speed. Stepwise regression equations predicting delayed memory determined that processing speed most significantly predicted delayed visual memory, even after controlling for immediate visual memory. No significant relationships emerged between verbal memory and non-memory neuropsychological scores.Conclusions: This is the first study to examine neuropsychological dispersion and relationships among domains of cognitive functioning in EI. Current results suggested that neuropsychological dispersion is not a marker of general functioning or severity of injury in EI patients, but may represent more specific processing speed abilities. Processing speed predicts delayed visual memory performance in EI patients, which should be considered in interpreting test scores during evaluations.
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Affiliation(s)
- Jessica L Paxton
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Psychology, Roosevelt University, Chicago, IL, USA
| | - Zachary J Resch
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Bailey Cation
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Psychology, Roosevelt University, Chicago, IL, USA
| | - Franchezka Lapitan
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Psychology, Roosevelt University, Chicago, IL, USA
| | - Maximillian A Obolsky
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Psychology, Roosevelt University, Chicago, IL, USA
| | - Veroly Calderone
- The Chicago Electrical Trauma Rehabilitation Institute (CETRI), Chicago, IL, USA
| | - Joseph W Fink
- The Chicago Electrical Trauma Rehabilitation Institute (CETRI), Chicago, IL, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Raphael C Lee
- The Chicago Electrical Trauma Rehabilitation Institute (CETRI), Chicago, IL, USA.,Departments of Surgery, Medicine and Organismal Biology, University of Chicago, Chicago, IL, USA
| | - Jason R Soble
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Neurology, University of Illinois College of Medicine, Chicago, IL, USA
| | - Neil H Pliskin
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,The Chicago Electrical Trauma Rehabilitation Institute (CETRI), Chicago, IL, USA.,Department of Neurology, University of Illinois College of Medicine, Chicago, IL, USA
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12
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Biering K, Vestergaard JM, Kærgaard A, Carstensen O, Nielsen KJ. Mental disorders following electrical injuries-A register-based, matched cohort study. PLoS One 2021; 16:e0247317. [PMID: 33617562 PMCID: PMC7899322 DOI: 10.1371/journal.pone.0247317] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/05/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Electrical injuries happen every day in homes and workplaces. Not only may these injuries cause physical damage and disability, they may also cause mental disorders. The aim of this study was to investigate if persons with an electrical injury suffer from mental disorders in the following years. Material and methods In a prospective matched cohort design, we identified 14.112 electrical injuries in two Danish registries and matched these with persons with dislocation/sprain injuries or eye injuries, respectively, as well as with persons from the workforce from the same occupation, using year of injury, sex and age as matching variables. We identified possible outcomes in terms of mental diagnoses in the Danish National Patient registry, based on literature, including reviews, original studies and case-reports as well as experiences from clinical praxis. The associations were analyzed using conditional cox- and logistic regression. Results We found that the following of the examined outcomes were associated with exposure to an electrical injury compared to the matched controls. Some of the outcomes showed the strongest associations shortly after the injury, namely ‘mental disorders due to known physiological condition’, ‘anxiety and adjustment disorders’, and especially the ‘Post Traumatic Stress Disorder (PTSD)’ subgroup. The same pattern was seen for ‘Depression’ although the associations were weaker. Other conditions took time to develop (‘Somatoform disorders’), or were only present in the time to event analysis (‘other non-psychotic mental disorders’ and ‘sleep disorders’). The findings were consistent in all three matches, with the highest risk estimates in the occupation match. Conclusion Electrical injuries may result in mental disorders, both acute and several years after. However, the absolute risk is limited as most of the outcomes are rare.
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Affiliation(s)
- Karin Biering
- Department of Occupational Medicine–University Research Clinic, Danish Ramazzini Centre, Regional Hospital West Jutland, Herning, Denmark
- * E-mail:
| | - Jesper Medom Vestergaard
- Department of Occupational Medicine–University Research Clinic, Danish Ramazzini Centre, Regional Hospital West Jutland, Herning, Denmark
| | - Anette Kærgaard
- Department of Occupational Medicine–University Research Clinic, Danish Ramazzini Centre, Regional Hospital West Jutland, Herning, Denmark
| | - Ole Carstensen
- Department of Occupational Medicine–University Research Clinic, Danish Ramazzini Centre, Regional Hospital West Jutland, Herning, Denmark
| | - Kent J. Nielsen
- Department of Occupational Medicine–University Research Clinic, Danish Ramazzini Centre, Regional Hospital West Jutland, Herning, Denmark
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13
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Biering K, Vestergaard JM, Nielsen KJ, Carstensen O, Kærgaard A. Contacts with general practitioner, sick leave and work participation after electrical injuries: a register-based, matched cohort study. Occup Environ Med 2020; 78:54-60. [PMID: 33139345 DOI: 10.1136/oemed-2020-106858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/09/2020] [Accepted: 09/22/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Exposure to electrical current may cause injury with both mental and physiological consequences. This may lead to increased contacts with general practitioners (GP) and the injured person may develop reduced ability to work. We aimed to examine these outcomes in terms of work-participation, long-term sick leave and contacts with GPs. METHODS In a matched cohort design, we identified 14 112 electrical injuries in two registries and matched these with both patients with distorsion injuries or eye injuries, and with persons from the same occupation, using year of injury, sex and age for matching. We defined the outcomes based on register information regarding contacts with GPs and public transfer income. After the injury, we determined if the person had a long-term sick leave episode during the first 6, 12 months and 5 years. We calculated work participation during the year and 5 years and the number of GP contacts in the year of the injury, the year after and 5 years after the injury and dichotomised this at twice the mean number of contacts in the study population. The associations were analysed using conditional logistic regression. RESULTS We found increased risk for all defined outcomes, with the highest estimates in the occupation match. The risk estimates were similar over time. Adjusting for previous work participation increased the estimates slightly, whereas adjusting for previous contacts with GPs reduced the estimates. Restricting to those with at longer hospitalisation increased the estimates. CONCLUSION Electrical injuries increase risk of long-term sick leave, low work participation and increased contacts with GPs.
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Affiliation(s)
- Karin Biering
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, Herning, Denmark
| | - Jesper Medom Vestergaard
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, Herning, Denmark
| | - Kent Jacob Nielsen
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, Herning, Denmark
| | - Ole Carstensen
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, Herning, Denmark
| | - Anette Kærgaard
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, Herning, Denmark
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14
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Stockly O, Wolfe A, Espinoza L, Simko L, Kowalske K, Carrougher G, Gibran N, Bamer A, Meyer W, Rosenberg M, Rosenberg L, Kazis L, Ryan C, Schneider J. The impact of electrical injuries on long-term outcomes: A Burn Model System National Database study. Burns 2020; 46:352-359. [DOI: 10.1016/j.burns.2019.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/17/2019] [Accepted: 07/24/2019] [Indexed: 12/21/2022]
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15
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Thomée S, Österberg K, Rådman L, Jakobsson K. Cognition and mental wellbeing after electrical accidents: a survey and a clinical study among Swedish male electricians. Int Arch Occup Environ Health 2020; 93:683-696. [PMID: 32036424 PMCID: PMC7320954 DOI: 10.1007/s00420-020-01520-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 01/20/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose was to examine long-term consequences of exposure to electrical current passing through the body. We investigated (1) whether electricians after having experienced an electrical accident report more cognitive problems and lower mental wellbeing and (2) have objectively verifiable reduced cognitive function; and (3) which circumstances at the time of the accident affect long-term subjective cognitive function and mental wellbeing? METHODS A survey of male electricians who had experienced electrical accidents (n = 510) and a clinical study in a subsample (n = 23) who reported residual health problems was carried out. Both groups were examined regarding subjective cognitive function (Euroquest-9) and mental wellbeing (Symptom Checklist-90 subscales). The clinical study included neuropsychological tests of memory, attention, spatial function, and premorbid intellectual capacity. A matched control group was retrieved from reference data. RESULTS The survey participants reported more cognitive problems and lower mental wellbeing than referents. Of the examined circumstances, having experienced mortal fear at the time of the accident and health complaints, especially mental symptoms, for > 1 week after the accident were the most significant risk factors for later subjective cognitive problems and lower mental wellbeing. The only statistically significant difference in neuropsychological tests was better performance in part of the memory tests by the clinical study group compared to the control group. CONCLUSIONS The participants reported more cognitive problems and lower mental wellbeing than referents, but no long-term objective cognitive dysfunction was detected. Emotional response at the time of the accident and health complaints in the aftermath of the accident may constitute important indications for medical and psychological follow-ups.
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Affiliation(s)
- Sara Thomée
- Department of Psychology, University of Gothenburg, P.O. Box 500, 405 30, Gothenburg, Sweden.
| | - Kai Österberg
- Department of Psychology, Lund University, P.O. Box 213, 221 00, Lund, Sweden
| | - Lisa Rådman
- Department of Occupational and Environmental Medicine, Örebro University Hospital, 701 85, Örebro, Sweden.,Department of Physiotherapy, School of Medical Sciences, Örebro University, 701 82, Örebro, Sweden
| | - Kristina Jakobsson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, P.O. Box 414, 405 30, Gothenburg, Sweden.,Occupational and Environmental Medicine, Sahlgrenska University Hospital, P.O. Box 414, 405 30, Gothenburg, Sweden
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16
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Ding H, Huang M, Li D, Lin Y, Qian W. Epidemiology of electrical burns: a 10-year retrospective analysis of 376 cases at a burn centre in South China. J Int Med Res 2019; 48:300060519891325. [PMID: 31854209 PMCID: PMC7782948 DOI: 10.1177/0300060519891325] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To investigate the epidemiological profile and associated outcomes of electrical injuries at a major burn centre in southern China. METHODS This retrospective study enrolled consecutive electrical burn patients admitted to the burn centre of the First Affiliated Hospital of Guangxi Medical University between 2008 and 2017. Demographic and clinical data and outcomes were recorded. Mann-Whitney U tests/Pearson's chi-squared tests were used to examine the differences between low-voltage and high-voltage injuries. RESULTS There were 217 high-voltage injuries and 159 low-voltage injuries. High-voltage burns were frequently observed between March and August, and low-voltage burns peaked between June and September. Burn patients were mainly men. Most burns occurred in participants aged 21 to 50 years and in industrial workers and electricians at work or householders at home. Only one person with high-voltage burns died (a mortality rate of 0.46%). Amputation rates were 37.33% for high-voltage burns and 22.01% for low-voltage burns. High-voltage injuries were associated with more extensive burns, longer hospital stays, and more complications and amputations. CONCLUSIONS More attention should be paid to prevention of electrical burns in male adults. Particular focus is needed on industrial workers, incidents in the spring and summer, and high-voltage injuries.
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Affiliation(s)
- Huarong Ding
- Department of Burn and Plastic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Meimei Huang
- Department of Plastic and Aesthetic Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Dehui Li
- Department of Burn and Plastic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuan Lin
- Department of Burn and Plastic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wei Qian
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Key Laboratory of Disease Proteomics of Chongqing, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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17
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Soble JR, Resch ZJ, Schulze ET, Paxton JL, Cation B, Friedhoff C, Costin C, Fink JW, Lee RC, Pliskin NH. Examination of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) validity and substantive scales in patients with electrical injury. Clin Neuropsychol 2019; 33:1501-1515. [DOI: 10.1080/13854046.2019.1616114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jason R. Soble
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Neurology, University of Illinois College of Medicine, Chicago, IL, USA
| | - Zachary J. Resch
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Evan T. Schulze
- Department of Neurology, Saint Louis University, St. Louis, MO, USA
| | | | - Bailey Cation
- Department of Psychology, Roosevelt University, Chicago, IL, USA
| | - Claire Friedhoff
- Department of Psychology, Roosevelt University, Chicago, IL, USA
| | - Colleen Costin
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Illinois School of Professional Psychology, Schaumburg, IL, USA
| | - Joseph W. Fink
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
- The Chicago Electrical Trauma Rehabilitation Institute (CETRI), Chicago, IL, USA
| | - Raphael C. Lee
- The Chicago Electrical Trauma Rehabilitation Institute (CETRI), Chicago, IL, USA
- Departments of Surgery, Medicine and Organismal Biology, University of Chicago, Chicago, IL, USA
| | - Neil H. Pliskin
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Neurology, University of Illinois College of Medicine, Chicago, IL, USA
- The Chicago Electrical Trauma Rehabilitation Institute (CETRI), Chicago, IL, USA
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18
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Radulovic N, Mason SA, Rehou S, Godleski M, Jeschke MG. Acute and long-term clinical, neuropsychological and return-to-work sequelae following electrical injury: a retrospective cohort study. BMJ Open 2019; 9:e025990. [PMID: 31092649 PMCID: PMC6530314 DOI: 10.1136/bmjopen-2018-025990] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To determine acute and long-term clinical, neuropsychological, and return-to-work (RTW) effects of electrical injuries (EIs). This study aims to further contrast sequelae between low-voltage and high-voltage injuries (LVIs and HVIs). We hypothesise that all EIs will result in substantial adverse effects during both phases of management, with HVIs contributing to greater rates of sequelae. DESIGN Retrospective cohort study evaluating EI admissions between 1998 and 2015. SETTING Provincial burn centre and rehabilitation hospital specialising in EI management. PARTICIPANTS All EI admissions were reviewed for acute clinical outcomes (n=207). For long-term outcomes, rehabilitation patients, who were referred from the burn centre (n=63) or other burn units across the province (n=65), were screened for inclusion. Six patients were excluded due to pre-existing psychiatric conditions. This cohort (n=122) was assessed for long-term outcomes. Median time to first and last follow-up were 201 (68-766) and 980 (391-1409) days, respectively. OUTCOME MEASURES Acute and long-term clinical, neuropsychological and RTW sequelae. RESULTS Acute clinical complications included infections (14%) and amputations (13%). HVIs resulted in greater rates of these complications, including compartment syndrome (16% vs 4%, p=0.007) and rhabdomyolysis (12% vs 0%, p<0.001). Rates of acute neuropsychological sequelae were similar between voltage groups. Long-term outcomes were dominated by insomnia (68%), anxiety (62%), post-traumatic stress disorder (33%) and major depressive disorder (25%). Sleep difficulties (67%) were common following HVIs, while the LVI group most frequently experienced sleep difficulties (70%) and anxiety (70%). Ninety work-related EIs were available for RTW analysis. Sixty-one per cent returned to their preinjury employment and 19% were unable to return to any form of work. RTW rates were similar when compared between voltage groups. CONCLUSIONS This is the first investigation to determine acute and long-term patient outcomes post-EI as a continuum. Findings highlight substantial rates of neuropsychological and social sequelae, regardless of voltage. Specialised and individualised early interventions, including screening for mental health concerns, are imperative to improvingoutcomes of EI patients.
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Affiliation(s)
- Nada Radulovic
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Stephanie A Mason
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sarah Rehou
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew Godleski
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Physical Medicine and Rehabilitation, St. John's Rehab Hospital, Toronto, Ontario, Canada
| | - Marc G Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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19
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Reinbold C, Serror K, Mimoun M, Chaouat M, Marco O, Boccara D. Electrical Burns and Late Spontaneous Artery Ruptures: About Three Cases. J Burn Care Res 2019; 40:120-127. [PMID: 29767734 DOI: 10.1093/jbcr/irx005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Electrical burns are responsible for arterial and venous thrombosis, as well as weakening of the arteries. Immediate or delayed arterial occlusions, secondary to the aggression of the intima, or aneurysms, secondary to the aggression of the media, sometimes lead to artery ruptures without any warning signs. Such ruptures may trigger a hemorrhagic shock whose period of onset is variable and unpredictable. We are presenting here three cases treated in our department for electrical burns, whose complications were marked by hemorrhagic shock, secondary to late artery ruptures, sometimes occurring several months following the event. These case reports required performance of emergency hemostasis in order to control sudden bleeding, with first approach being placement of a tourniquet at the base of the limb and/or a compression point. Through these cases, we thought it is crucial to closely monitor for a few weeks all patients who were victims of electrical injury, even more so if it was associated with a compartment syndrome of one or more limbs and high rhabdomyolysis, which seem to be predictive factors of late artery ruptures in our case reports.
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Affiliation(s)
- C Reinbold
- Department of Reconstructive, Plastic and Aesthetic Surgery Burn Treatment Center, Saint-Louis Hospital, Paris, France
| | - K Serror
- Department of Reconstructive, Plastic and Aesthetic Surgery Burn Treatment Center, Saint-Louis Hospital, Paris, France
| | - M Mimoun
- Department of Reconstructive, Plastic and Aesthetic Surgery Burn Treatment Center, Saint-Louis Hospital, Paris, France
| | - M Chaouat
- Department of Reconstructive, Plastic and Aesthetic Surgery Burn Treatment Center, Saint-Louis Hospital, Paris, France
| | - O Marco
- Department of Reconstructive, Plastic and Aesthetic Surgery Burn Treatment Center, Saint-Louis Hospital, Paris, France
| | - D Boccara
- Department of Reconstructive, Plastic and Aesthetic Surgery Burn Treatment Center, Saint-Louis Hospital, Paris, France
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20
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Shih JG, Shahrokhi S, Jeschke MG. Review of Adult Electrical Burn Injury Outcomes Worldwide: An Analysis of Low-Voltage vs High-Voltage Electrical Injury. J Burn Care Res 2018; 38:e293-e298. [PMID: 27359191 PMCID: PMC5179293 DOI: 10.1097/bcr.0000000000000373] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aims of this article are to review low-voltage vs high-voltage electrical burn complications in adults and to identify novel areas that are not recognized to improve outcomes. An extensive literature search on electrical burn injuries was performed using OVID MEDLINE, PubMed, and EMBASE databases from 1946 to 2015. Studies relating to outcomes of electrical injury in the adult population (≥18 years of age) were included in the study. Forty-one single-institution publications with a total of 5485 electrical injury patients were identified and included in the present study. Fourty-four percent of these patients were low-voltage injuries (LVIs), 38.3% high-voltage injuries (HVIs), and 43.7% with voltage not otherwise specified. Forty-four percentage of studies did not characterize outcomes according to LHIs vs HVIs. Reported outcomes include surgical, medical, posttraumatic, and others (long-term/psychological/rehabilitative), all of which report greater incidence rates in HVI than in LVI. Only two studies report on psychological outcomes such as posttraumatic stress disorder. Mortality rates from electrical injuries are 2.6% in LVI, 5.2% in HVI, and 3.7% in not otherwise specified. Coroner's reports revealed a ratio of 2.4:1 for deaths caused by LVI compared with HVI. HVIs lead to greater morbidity and mortality than LVIs. However, the results of the coroner's reports suggest that immediate mortality from LVI may be underestimated. Furthermore, on the basis of this analysis, we conclude that the majority of studies report electrical injury outcomes; however, the majority of them do not analyze complications by low vs high voltage and often lack long-term psychological and rehabilitation outcomes after electrical injury indicating that a variety of central aspects are not being evaluated or assessed.
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Affiliation(s)
- Jessica G Shih
- From the *Division of Plastic Surgery, Department of Surgery and †Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ‡Department of Immunology, University of Toronto, Ontario, Canada; and §Sunnybrook Research Institute, Toronto, Ontario, Canada
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21
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Li H, Tan J, Zhou J, Yuan Z, Zhang J, Peng Y, Wu J, Luo G. Wound management and outcome of 595 electrical burns in a major burn center. J Surg Res 2017. [DOI: 10.1016/j.jss.2017.02.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Stergiou-Kita M, Mansfield E, Colantonio A, Moody J, Mantis S. What’s gender got to do with it? Examining masculinities, health and safety and return to work in male dominated skilled trades. Work 2016; 54:721-33. [DOI: 10.3233/wor-162322] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mary Stergiou-Kita
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Work & Health, Toronto, ON, Canada
| | | | - Angela Colantonio
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | - Steve Mantis
- Ontario Network of Injured Workers Groups (ONIWG), ON, Canada
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23
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Rådman L, Gunnarsson LG, Nilsagård Y, Nilsson T. Neurosensory findings among electricians with self-reported remaining symptoms after an electrical injury: A case series. Burns 2016; 42:1712-1720. [PMID: 27317339 DOI: 10.1016/j.burns.2016.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/20/2016] [Accepted: 05/21/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Symptoms described in previous studies indicate that electrical injury can cause longstanding injuries to the neurosensory nerves. The aim of the present case series was to objectively assess the profile of neurosensory dysfunction in electricians in relation to high voltage or low voltage electrical injury and the "no-let-go phenomenon". METHODS Twenty-three Swedish male electricians exposed to electrical injury were studied by using a battery of clinical instruments, including quantitative sensory testing (QST). The clinical test followed a predetermined order of assessments: thermal perceptions thresholds, vibration perception thresholds, tactile gnosis (the Shape and Texture Identification test), manual dexterity (Purdue Pegboard Test), and grip strength. In addition, pain was studied by means of a questionnaire, and a colour chart was used for estimation of white fingers. RESULTS The main findings in the present case series were reduced thermal perceptions thresholds, where half of the group showed abnormal values for warm thermal perception and/or cold thermal perception. Also, the tactile gnosis and manual dexterity were reduced. High voltage injury was associated with more reduced sensibility compared to those with low voltage. CONCLUSION Neurosensory injury can be objectively assessed after an electrical injury by using QST with thermal perception thresholds. The findings are consistent with injuries to small nerve fibres. In the clinical setting thermal perception threshold is therefore recommended, in addition to tests of tactile gnosis and manual dexterity (Purdue Pegboard).
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Affiliation(s)
- Lisa Rådman
- Department of Occupational and Environmental Medicine, Faculty of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden; Department of Physiotherapy, School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden.
| | - Lars-Gunnar Gunnarsson
- Department of Occupational and Environmental Medicine, Faculty of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden; School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden.
| | - Ylva Nilsagård
- University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, SE 701 82 Örebro, Sweden.
| | - Tohr Nilsson
- Department of Occupational and Environmental Medicine, Umeå University, 90187 Umeå, Sweden.
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Electrical injury in relation to voltage, “no-let-go” phenomenon, symptoms and perceived safety culture: a survey of Swedish male electricians. Int Arch Occup Environ Health 2015; 89:261-70. [DOI: 10.1007/s00420-015-1069-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 06/24/2015] [Indexed: 11/26/2022]
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Lunawat A, Datey SM, Vishwani A, Vashistha R, Singh V, Maheshwari T. Evaluation of quantum of disability as sequelae of electric burn injuries. J Clin Diagn Res 2015; 9:PC01-4. [PMID: 25954658 DOI: 10.7860/jcdr/2015/12243.5625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 01/27/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND All will agree that invention of electricity has changed the world. Today nobody can think of living without an uninterrupted supply. Electricity is definitely a boon to the mankind but this turns into a curse when it becomes a cause of disaster. Electrical burn injuries are the most destructive injuries with a potential of causing significant functional disability and extensive disfigurement in the survivors. MATERIALS AND METHODS We carried out a retrospective observational study on the 110 patients of electric burns admitted to our hospital between January 2007 and October 2014. The aim of the study was to determine the demographic and clinical profile of patients who had sustained electrical burn injury, with a special emphasis on limb loss. Section-2 of Workman's Compensation Act 1923 was used for the calculation of an individual's disability due to amputation. All the data was analysed using method of simple percentages and presented in a tabular form. RESULT Forty eight patients (43.63%) of electric burn belonged to the age group of 21-30 y, with male preponderance (M:F:: 93.6 : 6.4). This shows that the individual affected more often are invariably the breadwinners of the family.Twenty four, out of these 110 patients have undergone one or more than one amputation. Significantly the numbers of upper limb amputations have exceeded any other amputation in this study. Mortality in patients of electrical burns is 6.36% in comparison to mortality of 45.67% in all burn patients. CONCLUSION Loss of upper limb completely reduces the earning capacity of an individual. Future and fortune of the individual's family is jeopardized. Such accidents can be prevented by following safety norms and simple precautions while using the electrical equipment.
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Affiliation(s)
- Ajay Lunawat
- Associate Professor, Department of Surgery, Sri Aurobindo Medical College and PG institute , Indore, Madhya Pradesh, India
| | - Sanjay M Datey
- Professor, Department of Surgery, Sri Aurobindo Medical College and PG institute , Indore, Madhya Pradesh, India
| | - Avinash Vishwani
- Assistant Professor, Department of Surgery, Sri Aurobindo Medical College and PG institute , Indore, Madhya Pradesh, India
| | - Rishikant Vashistha
- Assistant Professor, Department of Surgery, Sri Aurobindo Medical College and PG institute , Indore, Madhya Pradesh, India
| | - Vikramaditya Singh
- Resident, Department of Surgery, Sri Aurobindo Medical College and PG institute , Indore, Madhya Pradesh, India
| | - Tanmay Maheshwari
- Resident, Department of Surgery, Sri Aurobindo Medical College and PG institute , Indore, Madhya Pradesh, India
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