gms | German Medical Science

Introduction: Electrical injuries are less frequent compared to other burn injuries, but very destructive with high morbidity and mortality, and associated with prolonged ICU and hospital stays and need for repeated procedures. The aim of this study was to determine epidemiology, management and outcome in patients with electrical injuries treated in a modern burns center.

Methods: Patient charts over 15 years were analyzed retrospectively to identify patients with electrical injuries admitted to the burns center at the University Hospital Zurich (1/2005-10/2019). Epidemiologic parameters, patient characteristics, injury type, management and outcome were reviewed.

Results: 89 patients were identified (average 6/year). Electrocution was predominant in males (86.5%), while 66.3% of patients had occupational and 33.7% nonoccupational injuries (11.2% attempted suicide). 24.7% suffered from pre-existing psychiatric conditions, including active addiction (12.4%). 21 patients suffered low voltage (<1000V), and 65 high voltage injuries (43 cases flash, 38 direct contact and 8 unknown mechanism) and 3 unclear (no witnesses). Patients had a wide age distribution (17y to 78y; median 47.5y), the majority (50.6 %) in the age group 21–40y. Length of ICU and hospital stays ranged from 0 to 152 (median 76 days), and 1 to 190 days (median 95.5 days), respectively. 43.8% of patients had specialized rehabilitation (range 0-357 days, median 178.5 days). Most common afflicted anatomical regions were upper extremity (91%), lower extremity (59.5%), trunk (51.7%) and head (51.7%). Low voltage victims had a burned TBSA of 8.4%, high voltage patients of 30.4% (average). Several procedures were done per patient (total of 515): low voltage injured had an average of 3.5 operations, of which 89.2% during the first acute admission and 10.8% during elective readmissions. High voltage patients had an average of 6.7 operations, 87.6% during the first acute admission, 9.6% during elective and 2.8% emergency readmissions. Most complications were sepsis (47.2%), pulmonary (44.9%), cerebral (41.6%), rhabdomyolysis (29.2%), and renal failure (20.2%). Limb amputation rate was 13.5%. Mortality was 9% in low voltage and 19% in high voltage injured. Most common cause of death was multiple organ failure (35%), septic shock (21%), cardiocirculatory arrest (7%), cerebral complication (7%). Most common procedures were tangential necrectomy (56.2%) and skin grafting (69.7%), fasciotomy (40.5%) and escharotomy (24.7%). Flap-based reconstruction was required in 22 patients (24.7%): 17 patients had local flaps (76% high voltage) and 11 patients had free flaps (73% high voltage). Three patients (14%) had flap failure and loss.

Conclusion: Electrical injuries (especially high voltage) are still cause of elevated morbidity (amputations and complications) and mortality, mostly involve young men in their earning period, to whom prevention should be focused on. Reconstruction remains frequently challenging.