Patient outcomes after electrical injury – a retrospective study

Abstract

Introduction People exposed to electrical injuries are often admitted to hospital for observation. Current evidence suggests that patients who have a normal ECG on admission after a low-voltage injury, with no loss of consciousness or initial cardiac arrest may be discharged home after a short observation time. Currently, there are no established standards for the duration of monitoring after electric shock, but 24 h of observation is the most commonly adopted approach. We carried out a retrospective study of patients admitted after electrical injuries to determine the in-hospital outcomes and 30-day mortality in these patients. Methods We performed a chart review of all patients with electrical injuries admitted to Østfold Hospital, Norway between the years 2001 and 2019, to determine in-hospital and 30-day mortality and the frequency of various cardiac and non-cardiac complications. Results Mean age of 465 included patients (88% males) was 31 years. Of all injuries, 329 (71%) were work-related, 17 (3.7%) involved loss of consciousness. Furthermore, 29/437 (6.6%) were high voltage (> 1000 V), and 243/401 (60.6%) were transthoracic injuries. 369 (79.4%) were discharged same day. None of the admitted patients died in hospital nor did any die within 30 days of admission, yielding a 30-day mortality of 0% (95% CI 0–0.8). At admission troponin was elevated in three (0.6%) patients, creatinine kinase (CK) in 30 (6.5%) and creatinine in six (1.3%). Electrocardiogram (ECG) abnormalities were described in 85 (18%) patients. No serious arrhythmias were detected. When comparing high- vs low-voltage or transthoracic vs other injuries, there were no significant differences between most of the outcomes, except for more ECG abnormalities in the transthoracic group, whereas more patients had elevated CK, and fewer discharged the same day in high-voltage injuries. Conclusion No in-hospital nor 30-day mortality or serious arrhythmias were encountered in those who were assessed, regardless of the type of injury. Troponin and creatinine were rarely elevated. It seems that conscious patients admitted with a normal ECG following a low-voltage injury may safely be discharged home after a quick clinical assessment including ECG.

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

“…An initial elevated troponin was observed in 17/533 (3.2%) of patients. In total, 197/533 patients (37.0%) received a new troponin assay at a median of 6 [ 4 – 11 ] hours after the first assay. Eight presented an increase of the initial troponin (including 6 patients with initial positive troponin).…”

“…Most cardiac events occur immediately after the accident resulting from the proarrhythmic effect of electric shock, but delayed ventricular arrhythmias have also been reported in rare cases [ 10 ]. Most studies did not report a delayed events [ 11 – 14 ].…”

Electrical Injuries: Cardiovascular Implication and Management

“…which can be classified by the underlying voltage as low-voltage (< 1000 alternating current or < 1500 direct current) and high-voltage (≥ 1000 alternating current or ≥ 1500 direct current) injuries. 2,3 These injuries, depending on a wide range of factors, are diverse, and often associated with high morbidity and mortality, ranging from minor skin burns to extensive life-threatening injuries of internal organs causing immediate respiratory and cardiac arrest. 4 In survivors, a particular concern relates to cardiac disturbances, arrhythmias, heart failure, cardiomyopathy, and myocardial infarction.…”

“…4 In survivors, a particular concern relates to cardiac disturbances, arrhythmias, heart failure, cardiomyopathy, and myocardial infarction. 2,5,6 The Occupational Safety and Health Administration (OSHA) reported that electrical injuries are the third leading cause of occupation-related deaths in the United States. 2 The reported mortality associated with electrical injuries ranges from 1% to 9.1%.…”

“…2,5,6 The Occupational Safety and Health Administration (OSHA) reported that electrical injuries are the third leading cause of occupation-related deaths in the United States. 2 The reported mortality associated with electrical injuries ranges from 1% to 9.1%. Cardiac complications related to electrical injuries include arrhythmias and myocardial tissue injuries, with a reported incidence of cardiac complications ranging from 3% to 40%.…”