Electrical injuries in children-a 6-year retrospective study

BACKGROUND

This study aimed to assess the clinical epidemiological characteristics of children with electrical injuries and discuss the countermeasures for the prevention of electrical injuries in children.

METHODS

The children with electrical injuries were grouped according to whether or not they were admitted to the hospital for treatment into inpatient and outpatient groups. Clinical data such as gender, causes of injury and injury-causing voltage distribution in different age groups were analyzed. The factors affecting hospitalization were subjected to χ2 test, Kruskal-Wallis H test, and logistic regression analysis.

RESULTS

A total of 321 children were included with 37 divided into inpatient group and 284 divided into outpatient group. The incidence of electrical injuries was highest in children ≤6 years old and in the summer. There were significantly different in gender, place of occurrence, cause of injury and injury-causing voltage between the two groups (p < 0.05). Injury-causing voltage is an independent risk factor affecting hospitalization of children with electrical injuries (OR = 0.116, 95 %CI = 0.040-0.334, p = 0.000). In children ≤6 years old, boys suffered electrical injuries more frequently than girls; battery powered vehicle (47.53 %) was primarily the cause of injury; most of the patients (64.64 %) were exposed to low voltage below 100 Vs, mainly in the case of adolescent children.

CONCLUSION

Male preschoolers accounted for the majority of electrical injury cases, and these accidents mostly happened in household electrical appliances and household battery cars. Overall, it is necessary to improve family electrical safety education and reinforce protective measures against electric injury to children.

Predictors of mortality following electrical and lightning injuries in Malawi: A decade of experience

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.

Abuse of defibrillator pads: Suicide by electrocution

We report a Case of a medical professional, with a very good knowledge of emergency medical devices, who committed suicide using defibrillator pads to electrocute. The decedent attached the defibrillator pads in the standard position on his chest and manually connected the terminals to an extension cord through an additional switching device. When he switched on the device, electricity passed through his heart. The autopsy showed attached defibrillator pads and severe skin burns beneath it. Scene findings were consistent with suicide. The cause of death was electrocution and manner of death was suicide. Suicide by electrocution is uncommon and suicide by electrocution using defibrillator pads has not been reported in English literature.

A rare case of low voltage electrical injury leading to bilateral femur fractures and vertebral body fractures: A case report and review of the literature

Introduction and importance

Low voltage electrical injuries (less than 1000 V) can produce enough tetany to cause fractures, usually of the upper extremities. Simultaneous bilateral fractures of the femoral neck are an extremely rare occurrence. It is even more uncommon for a young healthy male to suffer significant fractures from a low voltage injury.

Case presentation

A 25-year-old male attempted suicide by filling a bathtub with water and getting into it prior to dropping a blender into the water. He experienced full body convulsions but remained awake throughout the entire event. In the trauma bay his primary complaints were bilateral hip pain and back pain, without neurologic deficit. Radiological studies confirmed bilateral sub-capital femur fractures and thoracic vertebral fractures (compression fractures of T3, T4, T5, T6, T7, T9, and T11). The patient underwent bilateral open reduction and internal fixation (ORIF) of the femurs, while the spine fractures were treated with a thoracic-lumbar-sacral orthosis TLSO brace.

Clinical discussion

Low voltage electrical injury is more likely to lead to fractures in patients with chronic renal failure and metabolic conditions such as hypocalcemia, osetomalacia, and osteoporosis. Fractures after low voltage electrical injury are extremely uncommon and a high suspicion for these injuries should be maintained because if missed there is a high risk of morbidity and mortality.

Conclusion

We present a rare case of low voltage electrical injury by 120 V from a domestic US power supply, amplified by water conduction resulting in bilateral femoral neck fractures and vertebral body fractures.

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Fractures resulting from low voltage electrical injury are usually related to chronic renal failure, and metabolic conditions such as hypocalcemia, osetomalacia, and osteoporosis.

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Electrical injuries require a thorough assessment including voltage, duration of injury, environment (wet skin or humid environment), and any existing comorbidities.

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Bilateral femure and vertebral fractures are rare injuries following low-voltage electrical injury.

High voltage electrical injuries: outcomes & 1-year follow-up from a level 1 trauma centre

BACKGROUND

High voltage (>1000 V) electric injuries (HVEI) are rare, and dreaded due to profound myonecrosis and fatal arrhythmias. Trauma Centres are well equipped for acute and definitive treatment of injuries. Paucity of burn centres in Himalayan belt make trauma centres a prudent choice for management of HVEIs. We share our experience of HVEIs managed at our Level 1 Trauma Centre.

METHODS

Study conducted at All India Institute of Medical Sciences, Rishikesh. Patients enrolled from prospectively maintained Trauma Registry. HVEI defined as an electrical shock from a source running current of or more than 1000 Volts. All patients admitted to department of Trauma Surgery with diagnosis of HVEIs, over 17 months (May 2019-Sept 2020) included. Demographics, clinical course, morbidity and management noted. Data is presented descriptively.

RESULTS

Prevalence of HVEIs was 0.5% (n=8) among all trauma admissions; all patients were males with median age 25 years. Mode of injury accidental in 6 (75%). Seven patients (87.5%) had entry points in the upper extremity. All patients suffered thermal burns (median BSA 11%). Three patients (37.5%) had secondary fall, no concomitant injury found. Urine myoglobin & creatine kinase measured in all patients. No dysrhythmias detected in index or follow up ECGs. Four patients required emergent escharotomy, four underwent amputation. There was a median of 3 procedures per patient. Fasciotomy (n=6) and grafting (n=3) were commonest operative procedures. Multisystem involvement was seen in 3 patients. In-hospital mortality nil.

CONCLUSIONS

HVEIs are rare injuries, predominantly affecting upper extremity of young males. Amputation rates approach 50% despite expeditious surgical management of extremity burn due to progressive myonecrosis. Creatine kinase and urine myoglobin did not correlate with renal failure; ECG monitoring wasn't advantageous in patients with normal index ECG in our study. Modest BSA doesnot rule out visceral damage. Delayed hollow viscus perforation is a possibility in HVEIs involving parietal wall. Vocational loss is common due to high amputation rates of affected extremity, most commonly upper limb. Trauma team is well trained to provide acute, definitive and intensive care, and level I trauma centres with their integrated services are well suited to manage victims of HVEIs in LMICs.

Electrocutions in free-living black-tufted marmosets (Callithrix penicillata) in anthropogenic environments in the Federal District and surrounding areas, Brazil

Shrinking natural habitats exposes some non-human primates to the risk of accidents associated with electrical transmission lines. We examined dead marmosets (Callithrix penicillata) collected in the region from January 2015 to April 2018 to determine the animals' cause of death and for electrocuted animals we examined the locations the animals had died as well as the configuration of the power lines at these sites. We also recorded the sex of the animal, the body region affected, and characteristics of the injuries. We diagnosed electrocutions in 11% (n = 34) of the marmosets studied. Most of the affected animals were male (n = 22) with single or double sites of injury on the limbs. Animals were injured in urban (n = 26) and peri-urban (n = 8) areas on lower-voltage alternate current lines, and we detected no seasonality or hotspots of electrocution. Our findings suggest that movement along transmission lines composed of bundled conductors is a major factor in electrocutions of marmosets in the Federal District and surrounding areas. The planning of electrical power grid infrastructure should consider arboreal primates to prevent electrocutions.

Groin Flap in Paediatric Age Group to Salvage Hand after Electric Contact Burn: Challenges and Experience

INTRODUCTION

Electric contact burn is characterised by multiple wounds produced by entrance and exit of the current. Hand is most commonly involved in the same and children are particularly susceptible to such accidents.

AIM

To document effectiveness and challenges associated with the use of groin flap as an initial definitive treatment of electric contact burn in paediatric age group.

MATERIALS AND METHODS

From January 2015 to December 2016, 25 children up to 12 years of age, who were admitted at SMS Medical College, Jaipur, Rajasthan, India, after electric burn injury with hand defect and who were treated by pedicled groin flap at the Department of Plastic and Reconstructive Surgery, were included in the study. Details related to gender, age, type of voltage injury, sites of injury and postoperative complications were recorded. The groin flap was used in these children for coverage of hand and finger defect with exposed bone and tendon.

RESULTS

Normal functional results were seen in all children treated with pedicled groin flap and all were able to perform activities of daily living. All the children had satisfactory aesthetic result.

CONCLUSION

Although, groin flap was an uncomfortable procedure due to limb position that was particularly difficult for children, it was found to be a useful method to salvage hand and it resulted in favourable functional and aesthetic outcome in each case.

Pattern and profile of electric burn injury cases at a Burn centre

BACKGROUND

Electrical burns are quite different from thermal and chemical burns. This study is from a centre which deals with job related electric burn injuries alone and thus can give a pure account of the electric burns and discuss the related peculiarities. Study aims to highlight the differences in the mechanism of electric burn injury, its mode of presentation, morbidity, complications and thus the treatment strategies as compared to rest of the burn injuries.

METHODS

This is a descriptive case series study of first consecutive 61 electric burn victims treated at a Burn Unit and Plastic Surgery centre. Cases were admitted and resuscitated at the emergency, and further treated at burn unit. Thorough history, examination findings and operative procedures were recorded. Patients were photographed for record as well. Emergency operative procedures, wound management, soft tissue coverage procedures and complications during the hospital stay were recorded and studied.

RESULTS

Twenty cases (33%) were in the fifth decade of life. High voltage electric burn injury was seen in 42 (69%) of the cases. Whereas only 9 cases were treated conservatively, other 52 cases had 24 fasciotomies and 71 debridements. Series witnessed 10 expiries, and 22 amputations and all these were result of high voltage electric burns. Twenty eight soft tissue coverage procedures were carried out.

CONCLUSIONS

Electric burn injuries are altogether different from rest of the burn injuries and must be treated accordingly. These injuries are peculiar for ongoing damage, extensive trauma, complications and prolonged morbidity. Treatment requires a high degree of suspicion, more aggressive management to unfold and minimize the deep seated insult.

Stefan Jellinek (1871-1968): The only professor of electro-pathology

The exploding use of electricity in homes and industry in the second half of the 19th century was accompanied by many injuries and fatalities from electric currents. Their study by my father was the serendipitous outcome of his early work on possible blood pressure changes from electric currents in a career that started in internal medicine. It became his limited field of electro-pathology which embraced first aid, the care of the injured, histopathology and accident prevention. He was an enthusiastic teacher and collector of specimens, from tree trunks struck by lightning down to the microscopy of accidental and experimental electric lesions.

Outcome of occupational electrical injuries among French electric company workers: a retrospective report of 311 cases, 1996-2005

This study reviewed records of all electrical incidents involving work-related injury to employees Electricité de France (EDF) from 1996 through 2005 and analysed data for 311 incidents. The results are compared with 1231 electrical incidents that occurred during 1970-1979 and 996 incidents during 1980-1989. A total of 311 electrical incidents were observed. The medical consequences of electrical incident remain severe and particularly, the current fatality rate (3.2%) is similar to that recorded in the 1980s (2.7%) and 1970s (3.3%). Among individuals with non-fatal incidents, any change has occurred in the prevalence of permanent functional sequelae (23.6% in the 1970s vs. 27.6% in the 1980s and 32.5% currently). An increase in the incidence of neuropsychiatric sequelae (5.4% in the 1980s vs. 13% currently) has been observed and they are now the second most common type of sequelae after those directly related to burns. Among the neurological sequelae, peripheral nervous system disorders are the most common, as observed in the 1980s. Since the definition of post-traumatic stress disorder (PTSD) has changed between the two periods, we can only report that the current prevalence of PTSD is 7.6%. This study emphasises the need for specific management of neurological and psychological impairments after electrical injuries, including especially early recognition and initiation of effective treatment.

Electrical injuries in the US mining industry, 2000-2009

The U.S. National Institute for Occupational Safety and Health (NIOSH) Office of Mine Safety and Health Research (OMSHR) conducted a study of mining industry electrical injuries reported to the U.S. Mine Safety and Health Administration (MSHA) for the years 2000 to 2009. The findings of that study are detailed in this paper, and serve to characterize the circumstances surrounding electrical injuries and identify causal factors. The study included three tasks: 1) a direct review of mining industry occupational injury data compiled by MSHA, 2) interpretation of the narrative descriptions available for the injuries (from MSHA data) and 3) a separate examination of fatal electrical injuries. Eight-hundred sixty-five electrical injuries were reported during the 10-year period studied, with 39 of those being fatalities. This makes electrical injuries disproportionately fatal with respect to most other types of injuries in mining. Electrical injury rates were higher in coal mining than noncoal mining and, within the coal sector, rates were higher in underground operations than in surface operations. Of the 865 total cases, electrical and machine maintenance or repair activities were involved in 580 (69%), and electricians and mechanics were injured in 362 cases (42%). Of the 39 fatal electrical injuries, 27 (69%) involved electrical maintenance or repair work, and in 21 of these 27 cases, the failure to de-energize, lock-out and tag the circuit was the cause or a contributing factor. Also, contractor employees had a much greater chance of an electrical injury being fatal than did mine operator employees. The top three root causes for fatal electrical injuries were 1) no or inadequate lock-out and tagging, 2) failure of power system components and 3) contact of overhead electrical power lines by mobile equipment.