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Electrical injury – a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors
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...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984367/ https://www.ncbi.nlm.nih.gov/pubmed/29855384 http://dx.doi.org/10.1186/s13049-018-0513-2 |
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author | Gille, Jochen Schmidt, Thomas Dragu, Adrian Emich, Dimitri Hilbert-Carius, Peter Kremer, Thomas Raff, Thomas Reichelt, Beate Siafliakis, Apostolos Siemers, Frank Steen, Michael Struck, Manuel F. |
author_facet | Gille, Jochen Schmidt, Thomas Dragu, Adrian Emich, Dimitri Hilbert-Carius, Peter Kremer, Thomas Raff, Thomas Reichelt, Beate Siafliakis, Apostolos Siemers, Frank Steen, Michael Struck, Manuel F. |
author_sort | Gille, Jochen |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-5984367 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-59843672018-06-07 Electrical injury – a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors Gille, Jochen Schmidt, Thomas Dragu, Adrian Emich, Dimitri Hilbert-Carius, Peter Kremer, Thomas Raff, Thomas Reichelt, Beate Siafliakis, Apostolos Siemers, Frank Steen, Michael Struck, Manuel F. Scand J Trauma Resusc Emerg Med Original Research 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. BioMed Central 2018-05-31 /pmc/articles/PMC5984367/ /pubmed/29855384 http://dx.doi.org/10.1186/s13049-018-0513-2 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Original Research Gille, Jochen Schmidt, Thomas Dragu, Adrian Emich, Dimitri Hilbert-Carius, Peter Kremer, Thomas Raff, Thomas Reichelt, Beate Siafliakis, Apostolos Siemers, Frank Steen, Michael Struck, Manuel F. Electrical injury – a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors |
title | Electrical injury – a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors |
title_full | Electrical injury – a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors |
title_fullStr | Electrical injury – a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors |
title_full_unstemmed | Electrical injury – a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors |
title_short | Electrical injury – a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors |
title_sort | electrical injury – a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984367/ https://www.ncbi.nlm.nih.gov/pubmed/29855384 http://dx.doi.org/10.1186/s13049-018-0513-2 |
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