Electrocution Injuries: Three-Year Review of Patient Outcomes and Treatment Strategies
Aug 23, 2024
2024/8/22
A comprehensive study from the Burn Unit of Clinical Emergency Hospital Bucharest, Romania, presents a three-year review of electrical injuries, focusing on treatment strategies, morbidity, and mortality outcomes.
Electrocutions lead to high mortality rates in young active patients, requiring multidisciplinary care in specialized units. The study highlights key factors affecting prognosis and evaluates the effectiveness of treatment approaches.
1. A total of 23 male patients were analyzed over three years, with the most common injury being high-voltage electric burns affecting the upper body.
2. The average hospital stay was 34 days, with a standard deviation of 60. About 39% of patients developed complications, with infections being the most frequent.
3. Two-thirds of patients required mechanical ventilation, and 60% underwent immediate fasciotomy, with 9% requiring amputations.
4. Third-degree burns were observed in 87% of patients, with 43% mortality and 48% survival, highlighting the severity of these injuries.
5. The study underscores the importance of rapid surgical interventions such as fasciotomy and early excision in improving patient outcomes.
Electrical injuries are a severe type of trauma, often leading to extensive skin and tissue damage. They have a high mortality rate, particularly in young, active individuals. The current study aims to improve clinical treatment strategies by analyzing 23 cases of electrocution over a three-year period at the Clinical Emergency Hospital in Bucharest.
Method
The study used a retrospective cross-sectional method to analyze patient data from May 2016 to May 2019. Patients were selected based on electrical injury severity, either high or low voltage, and data was extracted from both digital and physical records. Multiple variables such as patient demographics, injury specifics, complications, and outcomes were analyzed using statistical tools, including Microsoft Excel and IBM SPSS.
Result
1. Patient Demographics and Injury Characteristics
The study found that all 23 patients involved in the analysis were male, with 91.3% of them being in the active working-age group. This reflects a trend where electrocution injuries most commonly affect individuals engaged in physically demanding jobs, particularly in environments with higher exposure to electrical risks. The majority of the patients (61%) came from urban areas, where industrial work is more prevalent, while the rest (39%) were from rural regions. This distribution suggests that electrical injuries can occur across different geographical and professional contexts but are more likely in urbanized, industrial settings.
In terms of the injuries sustained, 75% of the cases involved high-voltage electric burns, demonstrating the severe nature of electrocution events. Over 60% of the patients had burns covering more than 30% of their body surface area (TBSA), which correlates with a higher risk of severe complications and mortality. The most common TBSA range was 61-70%, affecting critical areas such as the upper body, including the head, neck, chest, and arms. Burns in these regions can have devastating consequences, leading to significant functional impairment.
Further, the patients exhibited third-degree burns in 87% of cases, indicating deep tissue damage that extends beyond the skin to muscles, nerves, and even bones. The severity of these burns directly impacted the survival rates and the extent of surgical interventions required. The high prevalence of third-degree burns underscores the importance of rapid medical intervention to prevent further deterioration and improve outcomes for these patients.
2. Complications and Mortality
Complications were common among the patients, with 39% developing serious issues during their hospital stay. Infections were the most frequent complication, affecting over half of the patients who developed complications (55%). Pneumonia was particularly prevalent, followed by urinary tract infections, wound infections, and gastrointestinal infections. These infections were largely linked to the severity of the burns, the length of hospital stays, and the use of mechanical ventilation, which increased the risk of nosocomial infections.
The mortality rate among the 23 patients was 43%, highlighting the life-threatening nature of electrical injuries, particularly when accompanied by extensive burns. The patients who succumbed to their injuries tended to have higher TBSA burn percentages and more severe complications, such as multiple organ failure resulting from sepsis. The study also noted that 48% of patients survived, with several undergoing long-term rehabilitation due to the lasting effects of their injuries, including neurological and cardiovascular complications.
The need for mechanical ventilation was significant, with two-thirds of patients requiring assisted breathing due to inhalation injuries or systemic complications caused by the electrocution. The average duration of mechanical ventilation was 427 hours, with some patients needing ventilation for as long as 7,200 hours. This prolonged need for respiratory support not only indicates the severity of the injuries but also contributes to the risk of secondary complications, such as ventilator-associated pneumonia.
High infection rates were linked to prolonged hospital stays.
3. Surgical Interventions
Surgical intervention played a critical role in the treatment of these patients, with two-thirds (67%) requiring emergency procedures to mitigate the effects of their injuries. Fasciotomies were performed in 60% of cases, primarily in the upper limbs, to relieve pressure and prevent compartment syndrome. The study emphasized that early intervention was crucial in preventing the loss of limbs or further tissue damage. Fasciotomies, in particular, were necessary in cases where electrical burns caused deep tissue necrosis, leading to increased pressure within the muscle compartments.
Among the patients, 9% required amputations due to the severity of tissue destruction caused by electrical burns. In cases where limbs were too damaged to salvage, amputation was performed to prevent life-threatening infections and further complications. The study highlighted that amputations were more common in patients who experienced high-voltage injuries, where the electrical current passed through the extremities, causing irreversible damage.
Early excision and grafting of third-degree burns were also identified as key procedures in reducing complications. By removing dead tissue early and replacing it with skin grafts, the risk of infection and sepsis was reduced significantly. The study found that patients who underwent early excision had shorter hospital stays and fewer complications compared to those who had delayed surgery. This underscores the importance of timely surgical intervention in improving the outcomes of patients with severe electrical burns.
Early surgery was critical in improving recovery outcomes.
Conclusion
This study highlights the devastating impact of electrocution injuries, with significant mortality and morbidity. The findings suggest that rapid, multidisciplinary treatment can improve patient outcomes. Moving forward, improvements in emergency protocols and early surgical intervention could further reduce complications and enhance recovery for electrocution victims.
