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Navarrete N, Rodriguez-Parra JD. Letter to the Editor regarding "Predictors of mortality following electrical and lightning injuries in Malawi: A decade of experience". Burns 2024:S0305-4179(24)00186-4. [PMID: 38987081 DOI: 10.1016/j.burns.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 06/08/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Norberto Navarrete
- Emergency Physician, Clinical Epidemiology, Burn Intensive Care Unit, Simón Bolívar Hospital, Bogotá, Colombia.
| | - Juan David Rodriguez-Parra
- Department of Burns and plastic surgery, Clinical Epidemiology, Simón Bolívar Hospital, Bogotá, Colombia.
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2
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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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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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5
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Sachkov AV, Spiridonova TG, Zhirkova EA, Medvedev AV, Rogal ML. [Serum creatine phosphokinase as a predictor of upper limb amputation in electrical trauma]. Khirurgiia (Mosk) 2023:47-52. [PMID: 37186650 DOI: 10.17116/hirurgia202305147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To study the relationship between serum creatine phosphokinase and outcomes of injury in victims with electrical burns. MATERIAL AND METHODS Among 40 patients with electrical injury, 7 (18%) ones underwent upper limb amputation. There were 37 (92.5%) men and 3 (7.5%) women aged 37 (28; 47) years. We analyzed total serum creatine phosphokinase and MB fraction on the first day in patients with and without amputations. RESULTS Total serum creatine phosphokinase exceeded the upper reference value in 11 out of 33 patients without amputation and in all 7 patients with limb amputation (p=0.001). Patients with limb amputation had significantly higher total serum creatine phosphokinase and MB fraction (p<0.001 and p=0.030, respectively). Logistic regression equation showed that high total serum creatine phosphokinase significantly influenced amputation rate (p<0.001), as evidenced by odds ratio (42.7, 95% CI 3.5-514.8). ROC analysis revealed the cut-off value of total serum creatine phosphokinase (950 IU/L). Sensitivity was 100% (63; 100), specificity - 94% (86; 94), positive predictive value - 78% (49; 78), negative predictive value - 100% (92; 100). CONCLUSION Total serum creatine phosphokinase depends only on severity of electrical and flame burns. Serum creatine phosphokinase is a predictor of upper limb amputation in patients with electrical injury. Total serum creatine phosphokinase ≥ 950 IU/L is significant for upper limb amputation (in CK-MB fraction within the reference values).
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Affiliation(s)
- A V Sachkov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - T G Spiridonova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - E A Zhirkova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A V Medvedev
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - M L Rogal
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
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Vaghardoost R, Saraee A, Ghavami Y, Sobouti B. Evaluation of Electrical Burn Injuries in Iran: A 7 year retrospective study. J Burn Care Res 2021; 43:104-108. [PMID: 33886962 DOI: 10.1093/jbcr/irab070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Electrical burn injuries can cause devastating and debilitating morbidities and impairments for patients. This cross-sectional descriptive study was performed on electrical burn patients hospitalized from 2014 to 2019 to evaluate electrical burn injuries' epidemiology and characteristics. A total number of 726 patients with the mean age of 31.17 years were evaluated for electrical burn injuries. Mean total burn surface area (TBSA) was 16.61 ± 12.56. Most victims were male (696 cases, 95.7%); and most patients did not have a constant job (n = 458, 63%). Most affected burn sites were hands (28.6%) and upper limbs (27.8%). A total number of 89 (12.2%) patients suffered amputations with the hand fingers (64 cases) as the most common site. Low voltage injuries were more common (n = 649 , 89%). Most incidents happened at the workplace (n =459 , 63%). Comparison of patients with high voltage and low voltage injuries showed significant correlations and statistical difference between these 2 groups regarding TBSA, mean hospital stays, escharectomy, fasciotomy, amputations, debridement, fracture and mortality rate (P = 0.001). Our observation revealed that electrical burn injuries are still significant causes of morbidity and mortality among trauma patients. In contrast to previous studies, low voltage injuries were more common than high voltage ones. We propose improvements in the manufacturing of electrical appliances; paying attention to safety measures will reduce thenumber of incidents. Moreover, training and education play important roles in reducing the number of incidents and mortality rates.
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Affiliation(s)
- Reza Vaghardoost
- Plastic and Reconstructive Surgeon, Burn Research Center, Hazrate Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Saraee
- Resident physicians, Plastic and Reconstructive Surgery, Shahid Motahari Hospital, Iran University of Medical Sciences
| | - Yaser Ghavami
- Research Specialist, Burn Research Center, Shahid Motahari Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Sobouti
- Pediatrics Infectious Diseases, Ali-Asghar Hospital, Iran University of Medical Sciences, Tehran, Iran
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Schweizer R, Pedrazzi N, Klein HJ, Gentzsch T, Kim BS, Giovanoli P, Plock JA. Risk Factors for Mortality and Prolonged Hospitalization in Electric Burn Injuries. J Burn Care Res 2020; 42:505-512. [PMID: 33137191 DOI: 10.1093/jbcr/iraa192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Electrical injuries are rare, but very destructive with high morbidity and mortality, prolonged hospital length of stay and need for repeated procedures. The aim of study was to investigate characteristics and management of electrical injuries and predisposing factors for mortality and prolonged length of stay. Patient charts were reviewed retrospectively to identify patients admitted with electrical injuries at the Zurich Burns Center (2005-2019). Patient characteristics, management, and outcome were analyzed and risk factors for mortality and prolonged hospitalization were assessed. Eighty-nine patients were included, mostly males (86.5%), between 21 and 40 years (50.6%), with high-voltage (74.2%) occupational injuries (66.3%). Median intensive care unit and hospital stays were 6 (first and third IQR: 2.0; 30.0) and 18 (9.0; 48.0) days. Low-voltage patients had a median of 2 (1.5; 3.0) procedures, compared to 4 (2.0; 10.8) in high-voltage. The amputation rate was 13.5%, and a total of 46 flaps were required. Fifty-four patients had at least one serious complication. Mortality was 18% in high-voltage patients, mostly after multiple organ failure (35%). High total body surface area (TBSA), renal failure and cardiovascular complications were risk factors for mortality (P < .001) in multivariate regression models. Determinants for prolonged hospital stay were TBSA and sepsis (P < .01), and additionally abdominal complications and limb loss for intensive care unit stay (P < .05). Electrical injuries are still cause of significant morbidity and mortality, mostly involve young men in their earning period. Several risk factors for in-hospital mortality and prolonged stay were identified and can support physicians in the management and decision making in these patients.
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Affiliation(s)
- Riccardo Schweizer
- Department of Plastic Surgery and Handsurgery, Burn Center, UniversitätsSpital Zürich, Switzerland
| | - Nadine Pedrazzi
- Department of Plastic Surgery and Handsurgery, Burn Center, UniversitätsSpital Zürich, Switzerland
| | - Holger J Klein
- Department of Plastic Surgery and Handsurgery, Burn Center, UniversitätsSpital Zürich, Switzerland
| | - Tony Gentzsch
- Department of Plastic Surgery and Handsurgery, Burn Center, UniversitätsSpital Zürich, Switzerland.,Department of Plastic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt, Germany
| | - Bong-Sung Kim
- Department of Plastic Surgery and Handsurgery, Burn Center, UniversitätsSpital Zürich, Switzerland
| | - Pietro Giovanoli
- Department of Plastic Surgery and Handsurgery, Burn Center, UniversitätsSpital Zürich, Switzerland
| | - Jan A Plock
- Department of Plastic Surgery and Handsurgery, Burn Center, UniversitätsSpital Zürich, Switzerland
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Mulder MB, Gilna GP, Iyengar RS, Quintana OD, Nardiello DC, Kaufman JI, Pizano LR, Namias N, Schulman CI, Proctor KG. Electrical Burns During Fruit Harvesting. J Burn Care Res 2020; 40:427-429. [PMID: 31051035 DOI: 10.1093/jbcr/irz050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Electrocutions during tree trimming or fruit harvesting are occasionally reported in the public media, but the actual incidence is unknown. Some fruit trees (eg, mango and avocado) can exceed 30 feet, with dense foliage concealing the fruit and overlying power lines so burns associated with harvesting these fruits are often exacerbated with falls. However, there are limited data on this subject. To fill this gap, we provide some of the first information on this unique injury pattern. All electrocutions from 2013 to 2018 were retrospectively reviewed at an ABA-verified burn center. Demographics, injury patterns, and complications were analyzed. Of 97 electrocutions, 22 (23%) were associated with fruit procurement. This population was aged 43 ± 14 years, 95% (n = 21) male, injury severity score of 15 ± 13, and total body surface area burned 4% [1%-9%]. Third-degree burns were present in 36% (n = 8). ICU admission was required in 59% (n = 13) and 39% of the survivors required operative interventions for the burn. Compartment syndrome occurred in 18% (n = 4) and 14% (n = 3) patients required amputations. Falls complicated the care in 50% (n = 11), with associated head, chest, and/or extremity trauma. Mortality was 32% (n = 7), with three patients presenting dead on arrival. All but 3 injuries occurred between June and December, coinciding with mango and avocado season. Electrocution during fruit picking is a seasonal injury often exacerbated by falls. Management is challenging, and favorable outcome depends on recognition of the complexity of the polytrauma.
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Affiliation(s)
- Michelle B Mulder
- Dewitt Daughtry Department of Surgery Divisions of Trauma, Burns, & Surgical Critical Care, University of Miami Miller School of Medicine and Ryder Trauma Center, Miami, Florida
| | - Gareth P Gilna
- Dewitt Daughtry Department of Surgery Divisions of Trauma, Burns, & Surgical Critical Care, University of Miami Miller School of Medicine and Ryder Trauma Center, Miami, Florida
| | - Rahul S Iyengar
- Dewitt Daughtry Department of Surgery Divisions of Trauma, Burns, & Surgical Critical Care, University of Miami Miller School of Medicine and Ryder Trauma Center, Miami, Florida
| | - Olga D Quintana
- Dewitt Daughtry Department of Surgery Divisions of Trauma, Burns, & Surgical Critical Care, University of Miami Miller School of Medicine and Ryder Trauma Center, Miami, Florida
| | - Dawn C Nardiello
- Dewitt Daughtry Department of Surgery Divisions of Trauma, Burns, & Surgical Critical Care, University of Miami Miller School of Medicine and Ryder Trauma Center, Miami, Florida
| | - Joyce I Kaufman
- Dewitt Daughtry Department of Surgery Divisions of Trauma, Burns, & Surgical Critical Care, University of Miami Miller School of Medicine and Ryder Trauma Center, Miami, Florida
| | - Louis R Pizano
- Dewitt Daughtry Department of Surgery Divisions of Trauma, Burns, & Surgical Critical Care, University of Miami Miller School of Medicine and Ryder Trauma Center, Miami, Florida
| | - Nicholas Namias
- Dewitt Daughtry Department of Surgery Divisions of Trauma, Burns, & Surgical Critical Care, University of Miami Miller School of Medicine and Ryder Trauma Center, Miami, Florida
| | - Carl I Schulman
- Dewitt Daughtry Department of Surgery Divisions of Trauma, Burns, & Surgical Critical Care, University of Miami Miller School of Medicine and Ryder Trauma Center, Miami, Florida
| | - Kenneth G Proctor
- Dewitt Daughtry Department of Surgery Divisions of Trauma, Burns, & Surgical Critical Care, University of Miami Miller School of Medicine and Ryder Trauma Center, Miami, Florida
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10
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Babu VS, Sharma S, Manas RK, Kaur C, R R. Study of serum creatine kinase and lactate dehydrogenase levels and their correlation in high-voltage electric contact burns. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01695-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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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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Gille J, Schmidt T, Dragu A, Emich D, Hilbert-Carius P, Kremer T, Raff T, Reichelt B, Siafliakis A, Siemers F, Steen M, Struck MF. Electrical injury - a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors. Scand J Trauma Resusc Emerg Med 2018; 26:43. [PMID: 29855384 PMCID: PMC5984367 DOI: 10.1186/s13049-018-0513-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/21/2018] [Indexed: 12/15/2022] Open
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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Affiliation(s)
- Jochen Gille
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany
| | - Thomas Schmidt
- Department of Medical Psychology, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Adrian Dragu
- Department of Plastic and Hand Surgery, Burn Center, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany.,Department of Plastic and Hand Surgery, University Center of Orthopedics and Trauma Surgery, University Hospital Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Germany
| | - Dimitri Emich
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany
| | - Peter Hilbert-Carius
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Thomas Kremer
- Department of Plastic and Hand Surgery, Burn Center, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany
| | - Thomas Raff
- Department of Plastic and Hand Surgery, Burn Center, St. Georg Hospital, Delitzscher Str. 141, 04129, Leipzig, Germany
| | - Beate Reichelt
- Department of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Apostolos Siafliakis
- Department of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Frank Siemers
- Department of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Michael Steen
- Department of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany
| | - Manuel F Struck
- Department of Plastic and Hand Surgery, Burn Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112, Halle, Germany. .,Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
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Zikaj G, Xhepa G, Belba G, Kola N, Isaraj S. Electrical Burns and Their Treatment in a Tertiary Hospital in Albania. Open Access Maced J Med Sci 2018; 6:835-838. [PMID: 29875855 PMCID: PMC5979827 DOI: 10.3889/oamjms.2018.206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/13/2018] [Accepted: 04/14/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION: The electrical current burns represent a very aggressive pathology that leaves many functional and aesthetic consequences. AIM: To evaluate the epidemiology of electrical burn injury and its associated complications and treatment. MATERIAL AND METHODS: Demographic data, aetiology, burn percentage and other measures related to electrical burn injury of 33 electrical burn patients in a tertiary hospital during the years 2015-2017. RESULTS: The mean age of patients is 31 (± 8.3) years old with a predominance of males (94%). The vast majority of injuries occurred at work (p < 0.01), superior extremities were more affected with hand (21.2%) and fingers (18.2%) being the main point of contact (p < 0.01). Muscular fasciotomy was performed in all patients who were treated surgically (n = 27), amputation was performed in 11 (40.7%) of cases, but amputated sites were more than the number of patients affected. Myoglobinuria (39.4%), cardio-respiratory distress (12.1%) contusion cerebri (6.1%), were the complication encountered in patients. CONCLUSIONS: Electrical burn injuries are still amongst the highest accident-related morbidities. Educating the population about the dangers and hazards associated with improper use of electrical devices and instruments is imperative.
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Affiliation(s)
- Gentian Zikaj
- Institute of Public Health - Epidemiology and Biostatistics, 80 Aleksander Moisiu Str, Tirana, Albania
| | - Gezim Xhepa
- Department of Morphology, Clinic of Plastic and Burn Surgery, University Hospital Center "Mother Teresa", Faculty of Medicine, Tirana, Albania
| | - Gjergji Belba
- General Surgery, University Hospital Center "Mother Teresa", Tirana, Albania
| | - Nardi Kola
- Service of Burns and Plastic Surgery, UHC Mother Tereza, Rruga e Dibres Nr 370, Tirana, Albania
| | - Sokol Isaraj
- Service of Burns and Plastic Surgery, UHC Mother Tereza, Rruga e Dibres Nr 370, Tirana, Albania
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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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Amputations in the burn unit: A retrospective analysis of 82 patients across 12 years. Burns 2017; 43:1449-1454. [DOI: 10.1016/j.burns.2017.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/19/2017] [Accepted: 04/05/2017] [Indexed: 11/22/2022]
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Applications of 256-Slice, Spiral Computed Tomography Perfusion Scanning in Limb Salvage After High-Voltage Electrical Injury. Disaster Med Public Health Prep 2017; 12:478-485. [PMID: 28899442 DOI: 10.1017/dmp.2017.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to investigate the applications of intelligent 256-slice computed tomography (iCT) perfusion imaging in high-voltage electrical injuries (HVEIs). METHODS 256-slice iCT was used to perform perfusion scanning for 48 patients with HVEI to detect the perfusion parameters. RESULTS The blood flow (BF) and peak enhancement intensity (PEI) values of the plane lower than the amputation level of the diseased side (ALD) were smaller than those of the corresponding healthy side (P<0.05); therefore, the differences were statistically significant. The BF value of the plane beyond the ALD was bigger than that of the ALD (t=2.99 and P=0.042); therefore, the difference was statistically significant. The BF, PEI, and blood volume values of the plane below the ALD were smaller than those of the ALD (P<0.05); therefore, the differences were statistically significant. CONCLUSIONS The technique of 256-slice iCT perfusion imaging could provide richer and more comprehensive imaging data for the clinical treatment of HVEIs, thus exhibiting its benefit in reducing the disability of patients with HVEIs. (Disaster Med Public Health Preparedness. 2018;12:478-485).
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Bilateral posterior shoulder dislocation after electrical shock: A case report. Ann Med Surg (Lond) 2015; 4:417-21. [PMID: 26904192 PMCID: PMC4720719 DOI: 10.1016/j.amsu.2015.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/31/2015] [Accepted: 10/11/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction Posterior dislocation of the shoulder is a rare and commonly missed injury. Unilateral dislocations occur mostly due to trauma. Bilateral posterior shoulder dislocations are even more rare and result mainly from epileptic seizures. Electrical injury is a rare cause of posterior shoulder dislocation. Injury mechanism in electrical injury is similar to epileptic seizures, where the shoulder is forced to internal rotation, flexion and adduction. Presentation of case This report presents a case of bilateral posterior shoulder dislocation after electrical shock. We were able to find a few individual case reports describing this condition. The case was acute and humeral head impression defects were minor. Our treatment in this case consisted of closed reduction under general anesthesia and applying of orthoses which kept the shoulders in abduction and external rotation. A rehabilitation program was begun after 3 weeks of immobilization. After 6 months of injury the patient has returned to work. 20 months postoperatively, at final follow-up, he was painless and capable of performing all of his daily activities. Discussion The amount of bilateral shoulder dislocations after electrical injury is not reported but is known to be very rare. The aim of this case presentation is to report an example for this rare entity, highlight the difficulties in diagnosis and review the treatment options. Conclusion Physical examination and radiographic evaluation are important for quick and accurate diagnosis. Posterior dislocation of the shoulder is a rare and commonly missed injury. Electrical injury is a rare cause of posterior shoulder dislocation. Physical examination and radiographic evaluation are important for quick and accurate diagnosis. If the diagnosis is made early and the humeral head impression defect is less than 25%, closed reduction followed by a good rehabilitation program can lead to successful results.
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Karimi H, Momeni M, Vasigh M. Long term outcome and follow up of electrical injury. JOURNAL OF ACUTE DISEASE 2015. [DOI: 10.1016/s2221-6189(15)30018-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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