The occurrence of single and multiple organ dysfunction in pediatric electrical versus other thermal burns

Abstract

Background Multiple organ failure (MOF) is a major contributor to morbidity and mortality in burned children. While various complications induced by electrical injuries have been described, the incidence and severity of single organ failure (SOF) and MOF associated with this type of injury are unknown. The study was undertaken to compare the incidence and severity of SOF and MOF as well as other complications between electrically and thermally burned children. Patients and Methods Between 2001 and 2016, two hundred eighty-eight pediatric patients with electrical burns (EB, N=96) or thermal burns (CTR, N=192) were analyzed in this study. Demographic data, length of hospitalization, number and type of operations, amputations, and complications were statistically analyzed. Incidence of SOF and MOF was assessed using the DENVER2 classification in an additive mixed model over time. Compound scores and organ-specific scores for lung, heart, kidney, and liver were analyzed. Serum cytokine expression profiles of both groups were also compared over time. Significance was accepted at p<0.05. Results Both groups were comparable in age (CTR 11±5 years vs. EB 11±5 years), percent total body surface area burned (CTR 33±25% vs. EB 32±25%), and length of hospitalization (CTR 18±26 days vs. EB 18±21 days). The percentage of high voltage injury in the EB group was 64%. The incidence of MOF was lower in the EB group (2/96, 2.1%) than the CTR group (20/192, 10.4%; p<0.05). The incidence of single organ failure was comparable between groups. Incidence of pulmonary failure was comparable in both groups, but incidence of inhalation injury was significantly higher in the CTR group (p<0.0001). Patients in the EB group had more amputations (p<0.001), major amputations (p=0.001), and combined major amputations (p<0.01). Mortality was comparable between the groups. Serum cytokine expression profiles were also comparable between groups. Conclusions In pediatric patients, electrical injury is associated with a lower incidence of MOF than other thermal burns. Early and radical debridement of nonviable tissue is crucial to improve outcomes in the electrical burn patient population.

Electric shock–induced cardiac injuries requiring surgical intervention: Case series and a brief review

“…If the current reaches the threshold (and voltage) needed for electrocution, massive damage can occur to body tissues, including cardiac tissue, and fibrillation can result in cardiac arrest. An AC current of 30 mA or direct current of 300 to 500 mA can cause severe damage and ventricular fibrillation if it goes through the chest cavity for just a fraction of a second . If current has a direct pathway to the heart through a cardiac catheter or wire electrodes, even 1 mA can cause ventricular fibrillation and cardiac damage or arrest if not treated quickly by defibrillation.…”

Electric Shock–Induced Coronary Artery Thrombosis and Dissection

“…These records show that electric current exposure continues to rank seventh among the occupational exposures that cause fatal injury in the US workplace. In addition, in 2015 nonfatal electrical injuries resulted in an increase in days away from work by one third, to approximately 2,480 sustained injuries-the highest level since 2009 [6]. Understanding the pathophysiologic effects and taking the proper preventive measures, along with quick response and rapid treatment, are important to prevent these injuries [6].…”

“…Power supplies used domestically can introduce ventricular fibrillation by passing the chest cavity for a fraction of a second at a low current of 30 mA [6]. Current greater than 200 mA can lead to strong contractions to the degree that the heart muscle cannot move at all.…”

Catastrophic Member. Restoration of Elbow Flexion by Transferring Long Head from Triceps to Biceps

“…Catastrophic upper limb injuries are devastating injuries that affect many essential structures of both skin and muscle, tendon, vascular, nerve, and bone that generally lead to significant disability, either directly or through the psychosocial impact they produce [1,2]. That is why the return of the essential functions of the limb is fundamental and for this the most important thing is to restore the flexion of the elbow to position the hand in space, performing essential functions such as toilet and bringing the hand to the face or mouth [3].…”