Electrical Injuries and Neurosurgery: A Case Report and Review of Literature

Introduction Electrical injuries account for 5 to 27% of admissions to burn units. The nervous system is affected in as much as 21% of nervous injuries, with reported mortality. Case Report The authors report a case of a patient presenting to the neurosurgical service with a traumatic brain injury (TBI) caused due to an electrical burn. Available data was reviewed through a PubMed search of literature, with special attention to the nature of presentation, classification of such injuries, the pathophysiology of the events that arise, complications to be expected, and the guidelines for management. Conclusion It is possible for electrical injuries to cause TBIs requiring neurosurgical intervention.

Treatment approaches of electrical injuries

Background: The purpose of this study was to explore the differences in prehospital care, admission characteristics, burn intensive care, surgery and outcomes in patients requiring admission to a burn intensive care unit. Material and methods: The study was conducted on a group of 31 patients, who were hospitalized within the Clinical Hospital of Orthopedics and Traumatology in the period 2015-2019. The data analysis was carried out on the applied method of surgical treatment, the associated postoperative complications, antibiotic therapy applied, etc. Results: 27 out of the total number of patients underwent necrectomy and extensive wound debridement surgery in the first hours upon admission. 14 patients required additional decompression incisions in the underlying skin and fascia. 4 patients out of the total number presented visible signs of carbonization on the affected areas upon admission, therefore they were subjected to an emergency amputation. Out of 27 patients classified as “delayed emergency” cases, 13 patients were subjected to amputation of the corresponding segments. Conclusions: Electrical injuries are a severe cause of disability, as well as a challenging issue for reconstructive surgery, which is concerned with restoring the damaged structures with prosthetic amputation abutments, therefore improving the aesthetic and psychological appearance of the patients.

Unspecified pain and other soft tissue disorders following electrical injuries: a register-based matched cohort study

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.

STATE AND PROBLEMS OF PRODUCTION AND HOUSEHOLD ELECTROTRAUMATISM IN UKRAINE

Technogenic development of society has caused widespread use in the system «man – production environment» and the system «man – household environment» of household electrical equipment, industrial electrical installations. Failure to comply with the regulated rules of electrical safety of electric current leads to electrical injuries. Designs of electrical installations, equipment, electrical protective measures are constantly being improved. But the level of electrical injuries in Ukraine and abroad tends to increase. This leads to social and economic losses as a result of economic costs in accidents, employee deaths, loss of working time and so on. The most objective indicator of injury is fatal. Thus, the level of fatal injuries at work per 1,000 workers in the developed world compared to the same rate in Ukraine in the UK is 10 times less, in Japan 7 times less, in the US 3 times less. This situation requires analysis and development of appropriate measures to reduce the level of electrical injuries. The analysis of statistical data revealed that the highest level of electrical injuries is observed in the following areas: - in agriculture; - service sector; - in public utilities; - in everyday life. At the same time, the tendency of its growth in the non-productive sphere and the household sector is expressed. So, at present in the general list of accidents from action of an electric current household electric injuries make the largest part – more than 46%. This is due to the insufficient level of education of the population on electrical safety, operation of electrical equipment in high-risk areas or in particularly dangerous by the degree of electric shock. At the same time, the level of domestic electrical injuries is higher in rural than in urban areas. It was also found that the greatest danger is posed by mobile and portable electrical installations, power tools and internal wiring. In addition, the housing of such electrical installations is often grounded through one of the cores of the power cable, which is unacceptable. The reasons for the high level of electrical injuries also include non-compliance with regulated organizational measures to ensure occupational safety and the so-called «human» factor. To improve the situation, it is necessary to intensify and increase the level of training of the population and employees on electrical safety, development and application of more modern switching electrical protection.

Повышение безопасности электротехнического персонала путем профессионального отбора

The statistics of occupational injuries in the Russian Federation are analyzed. For 2019–2020 there was an increase in occupational injuries and fatal injuries. It was also revealed that among incidents at the workplace, electrical injuries are less common, but cases of electric shock most often result in high-severity injuries and fatal case. As a rule, electrical personnel suffer from electrical injuries. Professional selection of electrical personnel is proposed as one of the ways to reduce occupational injuries. Electrical personnel must have certain qualities (developed at the required level of thinking, attention, responsibility for the result of work, for their own and other people lives, communicative potential, moral standards, etc.) that allow employees to carry out their activities, which will contribute to improving occupational safety. Therefore, professional selection must consider the peculiarities of working with electrical installations. Occupational safety is also influenced by the tension of the labor process. In this regard, the fragments of the protocols on the indicators of the intensity of electrical personnel labor process, which were drawn up during the assessment of working conditions, were analyzed. It is noted that each profession related to electrical personnel differs in the class of working conditions according to the factors of labor process intensity at the workplace. Situations can also be observed when one profession at the different workplaces can have a different class of working conditions for the same indicators of labor process intensity. Based on the analysis of the protocols, it can be concluded that professional selection should consider the characteristics of the electrical personnel, as well as the classes of working conditions according to the indicators available in the protocols of the labor process intensity.

Electrical injuries in adult patients – 3 years overview

Electrocutions are a particular type of trauma, usually affecting young active people, leading to high morbidity and mortality rates in extensive injured patients. Those patients require complex, multidisciplinary treatment in specialized burn centers. We conducted a three-year retrospective study in the Burn Unit of the Clinical Emergency Hospital Bucharest, Romania, aiming to identify different factors that characterize electrical injuries, with the goal to improve our clinical practice, in order to decrease overall complications, the morbidity and mortality rates and obtain an optimal functional prognosis for those severely injured patients. Patient-related and injury-related parameters were analyzed, and particularities observed in our burn unit were noted. A clear understanding of the physiopathology of those injuries and their complications is essential for providing an optimal therapeutic strategy. Rapid initiation of systemic supportive measures, accurate diagnostic and an adequate surgical treatment, correctly conducted, are essential for improving the vital and functional prognostic of patients who suffer electric injuries.

Use of troponin assay after electrical injuries: a 15-year multicentre retrospective cohort in emergency departments

Background Patients with electrical injury are considered to be at risk of cardiac arrhythmia. Assessing the risk of developing a major adverse cardiac event (MACE) is the cornerstone of patient management. The aim of this study was to assess the performance of initial troponin and troponin rise to predict Major Adverse Cardiac Events (MACEs) in all patients with electrical injuries admitted to the Emergency Department. Methods This is a multicentre retrospective study in which consecutive patients with electrical injuries admitted to the Emergency Departments (ED) (adult and paediatric) of five French Hospitals were included between 2005 and 2019. The threshold for troponin elevation is based on the European Society of Cardiology guidelines for patients presenting without persistent ST segment elevation. The primary endpoint was the rate of MACE. Results A total of 785 included patients were admitted to ED with a first diagnosis of electrical injury during the study period. Troponin assays were performed in 533 patients (67.9%), including 465 of 663 adults (70.1%) and 68 of 122 children (55.7%) and 17/533 (3.2%) of patients had an initial elevated troponin. If none of the clinical criteria for MACE were present (i.e., previous known heart disease, exposure to a high voltage of ≥ 1000 Volts, initial loss of consciousness, or an abnormal initial ECG), this defined a low-risk subgroup (n = 573, 76.0%) that could be safely discharged. The initial positive troponin assay had a sensitivity of 83.3 (95% CI 35.9–99.6%), a specificity of 97.7 (95% CI 96.1–98.8%), a positive likelihood ratio 36.6 (95% CI 18.8–71.1%) and a negative predictive value of 99.9 (95% CI 99.2–99.9%) in predicting a MACE. Conclusions Troponin assay appears to be a predictive marker of MACE risk and should be considered in high-risk patients.

Epidemiology of Occupational Electrical Injuries

Electrical injuries are an uncommon but very destructive type of burn, with serious complications and disabilities for the victims. This study was conducted due to the importance of understanding the epidemiology of electrical accidents in planning to prevent their occurrence. This is a retrospective cross-sectional study that was performed on patients with electrical burns referred to Shahid Motahari Educational and Medical Center from 2017 to 2018. Patients’ information was entered in the researcher-made information registration form, including demographic and accident-related information. In this study, most of the accidents occurred in the workplace with high-voltage electricity. Contact with overhead cables and wires was the most common cause of injury. Excision and graft surgeries were the most common type of surgery. The variables of sex, age, length of hospital stay, and type of job had a significant relationship with the type of voltage (P < .05). The difference between the ratio of men to women and the length of hospitalization in the group of injured with high-voltage electricity was greater and most of these patients were construction workers. The variables of sex, nationality, length of hospital stay, and cause of the accident had a significant relationship with the type of job (P < .05). Construction workers are the main group at risk of electrical damage in Iran. Therefore, it is recommended to conduct more extensive studies in the field of recognizing and implementing practical methods of preventing electrical injuries, especially in high-risk work environments.

Patterns and outcomes of high-voltage versus low-voltage pediatric electrical injuries: an 8-year retrospective analysis of a tertiary-level burn center

Introduction Although electrical injuries (EIs) are rare traumas in the pediatric age group, they are considered one of the most devastating injuries. We aimed to evaluate the patterns and outcomes of pediatric high-voltage (HVI) vs. low-voltage injuries (LVIs), admitted to the burn center within the efforts of determining evidence-based data for contributing to burn prevention strategies. Methods A retrospective study was conducted on children with EIs hospitalized in the Burn Center of Adana City Training and Research Hospital (ACTRH) for eight years (2013-2020). Data including the patients’ clinical and demographic characteristics, the percentage of total body surface area with burns (TBSA%), length of hospital stay (LOS), exposure place, electrical current type, and treatment results were collected and analyzed. Results EIs were detected in 57 (2.5%) of 2243 acute pediatric burn injury admissions. EIs were most frequently observed in the form of HVIs, among children within the age range of 13-18 years, mostly in residential outdoor environments, where the high-power lines still passing close to the home roofs and balconies, resulting from contact with them. Besides, with a lesser extent in LVIs, in the home environment among children under five years, which was caused by connection with substandard electrical cords/poor-quality electrical devices and inserting an object into the electric sockets. Concerning the mean of TBSA%, HVIs suffered more extensive burns than LVIs. The most frequently affected anatomical regions among HV and LVIs were the upper limb, followed by the lower limb. While superficial partial- and deep partial-thickness burns were significantly more common among the LVIs, full thickness burns were more prevalent among the HVIs. The amputation rate was 12% which only one of them was major amputation (forearm above the elbow joint). HVIs had more elevated CK and CK-MB levels than LVIs but were not correlated with ECG findings. Only one death (caused by HVI) was observed, with a mortality rate of 1.8%. Conclusion Pediatric EIs are less common than scald or fire-flame related burns in this age group but can cause significant morbidity and even mortality, especially in severe burns. It is possible to prevent possible morbidity and mortality by strengthening compliance with safety precautions, especially with parental education and raising social awareness. In this context, taking necessary precautions for passing high voltage power lines under the ground, the standardization of electrical cables by the relevant legal regulations, the use of socket covers in homes, promoting the widespread use of residual current relays and arrangements to be taken against the use of illegal electricity are among measures for the prevention strategy.