Pain Influences Neuropsychological Performance Following Electrical Injury: A Cross-Sectional Study.

OBJECTIVE: Electrical injury (EI) is a significant, multifaceted trauma often with multi-domain cognitive sequelae, even when the expected current path does not pass through the brain. Chronic pain (CP) research suggests pain may affect cognition directly and indirectly by influencing emotional distress which then impacts cognitive functioning. As chronic pain may be critical to understanding EI-related cognitive difficulties, the aims of the current study were: examine the direct and indirect effects of pain on cognition following EI and compare the relationship between pain and cognition in EI and CP populations. METHOD: This cross-sectional study used data from a clinical sample of 50 patients with EI (84.0% male; Mage = 43.7 years) administered standardized measures of pain (Pain Patient Profile), depression, and neurocognitive functioning. A CP comparison sample of 93 patients was also included. RESULTS: Higher pain levels were associated with poorer attention/processing speed and executive functioning performance among patients with EI. Depression was significantly correlated with pain and mediated the relationship between pain and attention/processing speed in patients with EI. When comparing the patients with EI and CP, the relationship between pain and cognition was similar for both clinical groups. CONCLUSIONS: Findings indicate that pain impacts mood and cognition in patients with EI, and the influence of pain and its effect on cognition should be considered in the assessment and treatment of patients who have experienced an electrical injury.

Mental disorders following electrical injuries-A register-based, matched cohort study.

INTRODUCTION: Electrical injuries happen every day in homes and workplaces. Not only may these injuries cause physical damage and disability, they may also cause mental disorders. The aim of this study was to investigate if persons with an electrical injury suffer from mental disorders in the following years. MATERIAL AND METHODS: In a prospective matched cohort design, we identified 14.112 electrical injuries in two Danish registries and matched these with persons with dislocation/sprain injuries or eye injuries, respectively, as well as with persons from the workforce from the same occupation, using year of injury, sex and age as matching variables. We identified possible outcomes in terms of mental diagnoses in the Danish National Patient registry, based on literature, including reviews, original studies and case-reports as well as experiences from clinical praxis. The associations were analyzed using conditional cox- and logistic regression. RESULTS: We found that the following of the examined outcomes were associated with exposure to an electrical injury compared to the matched controls. Some of the outcomes showed the strongest associations shortly after the injury, namely 'mental disorders due to known physiological condition', 'anxiety and adjustment disorders', and especially the 'Post Traumatic Stress Disorder (PTSD)' subgroup. The same pattern was seen for 'Depression' although the associations were weaker. Other conditions took time to develop ('Somatoform disorders'), or were only present in the time to event analysis ('other non-psychotic mental disorders' and 'sleep disorders'). The findings were consistent in all three matches, with the highest risk estimates in the occupation match. CONCLUSION: Electrical injuries may result in mental disorders, both acute and several years after. However, the absolute risk is limited as most of the outcomes are rare.

Cognition and mental wellbeing after electrical accidents: a survey and a clinical study among Swedish male electricians.

PURPOSE: The purpose was to examine long-term consequences of exposure to electrical current passing through the body. We investigated (1) whether electricians after having experienced an electrical accident report more cognitive problems and lower mental wellbeing and (2) have objectively verifiable reduced cognitive function; and (3) which circumstances at the time of the accident affect long-term subjective cognitive function and mental wellbeing? METHODS: A survey of male electricians who had experienced electrical accidents (n = 510) and a clinical study in a subsample (n = 23) who reported residual health problems was carried out. Both groups were examined regarding subjective cognitive function (Euroquest-9) and mental wellbeing (Symptom Checklist-90 subscales). The clinical study included neuropsychological tests of memory, attention, spatial function, and premorbid intellectual capacity. A matched control group was retrieved from reference data. RESULTS: The survey participants reported more cognitive problems and lower mental wellbeing than referents. Of the examined circumstances, having experienced mortal fear at the time of the accident and health complaints, especially mental symptoms, for > 1 week after the accident were the most significant risk factors for later subjective cognitive problems and lower mental wellbeing. The only statistically significant difference in neuropsychological tests was better performance in part of the memory tests by the clinical study group compared to the control group. CONCLUSIONS: The participants reported more cognitive problems and lower mental wellbeing than referents, but no long-term objective cognitive dysfunction was detected. Emotional response at the time of the accident and health complaints in the aftermath of the accident may constitute important indications for medical and psychological follow-ups.

The impact of electrical injuries on long-term outcomes: A Burn Model System National Database study.

INTRODUCTION: Electrical injuries exhibit significant acute and long-term sequelae. Amputation and neurological deficits are common in electrical injury survivors. There is a paucity of information on the long-term outcomes of this population. Therefore, this study examines the long-term outcomes of electrical injuries by comparing them to fire/flame injuries. METHODS: Data from the Burn Model System National Database collected between 1996 and 2015 was examined. Demographic and clinical characteristics for adult burn survivors with electrical and fire/flame injuries were compared. Satisfaction With Life Scale (SWLS), Short Form-12 Physical Composite Score (SF-12 PCS), Short Form-12 Mental Composite Score (SF-12 MCS), and employment status were examined at 24 months post-injury. Linear and logistic regression models were used to assess differences in outcome measures between groups, controlling for demographic and clinical variables. RESULTS: A total of 1147 adult burn survivors (111 with electrical injuries; 1036 with fire/flame injuries) were included in this study. Persons with electrical injuries were more likely to be male and injured at work (p<0.001). SF-12 PCS scores were significantly worse for survivors with electrical injuries at 24 months post-injury than survivors with fire/flame injuries (p<0.01). Those with electrical injuries were nearly half as likely to be employed at 24 months post-injury than those with fire/flame injuries (p=0.002). There were no significant differences in SWLS and SF-12 MCS between groups. CONCLUSIONS: Adult survivors with electrical injuries reported worse physical health and were less likely to be employed at 24 months post-injury compared to survivors with fire/flame injuries. A more detailed understanding of return to work barriers and work accommodations is merited for the electrical injury population. Furthermore, the results of this study should inform future resource allocation for the physical health and employment needs of this population.

Acute and long-term clinical, neuropsychological and return-to-work sequelae following electrical injury: a retrospective cohort study.

OBJECTIVE: To determine acute and long-term clinical, neuropsychological, and return-to-work (RTW) effects of electrical injuries (EIs). This study aims to further contrast sequelae between low-voltage and high-voltage injuries (LVIs and HVIs). We hypothesise that all EIs will result in substantial adverse effects during both phases of management, with HVIs contributing to greater rates of sequelae. DESIGN: Retrospective cohort study evaluating EI admissions between 1998 and 2015. SETTING: Provincial burn centre and rehabilitation hospital specialising in EI management. PARTICIPANTS: All EI admissions were reviewed for acute clinical outcomes (n=207). For long-term outcomes, rehabilitation patients, who were referred from the burn centre (n=63) or other burn units across the province (n=65), were screened for inclusion. Six patients were excluded due to pre-existing psychiatric conditions. This cohort (n=122) was assessed for long-term outcomes. Median time to first and last follow-up were 201 (68-766) and 980 (391-1409) days, respectively. OUTCOME MEASURES: Acute and long-term clinical, neuropsychological and RTW sequelae. RESULTS: Acute clinical complications included infections (14%) and amputations (13%). HVIs resulted in greater rates of these complications, including compartment syndrome (16% vs 4%, p=0.007) and rhabdomyolysis (12% vs 0%, p<0.001). Rates of acute neuropsychological sequelae were similar between voltage groups. Long-term outcomes were dominated by insomnia (68%), anxiety (62%), post-traumatic stress disorder (33%) and major depressive disorder (25%). Sleep difficulties (67%) were common following HVIs, while the LVI group most frequently experienced sleep difficulties (70%) and anxiety (70%). Ninety work-related EIs were available for RTW analysis. Sixty-one per cent returned to their preinjury employment and 19% were unable to return to any form of work. RTW rates were similar when compared between voltage groups. CONCLUSIONS: This is the first investigation to determine acute and long-term patient outcomes post-EI as a continuum. Findings highlight substantial rates of neuropsychological and social sequelae, regardless of voltage. Specialised and individualised early interventions, including screening for mental health concerns, are imperative to improvingoutcomes of EI patients.

Perceived Electrical Injury: Misleading Symptomology Due to Multisensory Stimuli.

BACKGROUND: An electrical accident victim's recollection is often distorted by Bayesian inference in multisensory integration. For example, hearing the sound and seeing the bright flash of an electrical arc can create the false impression that someone had experienced an electrical shock. These subjects will often present to an emergency department seeking either treatment or reassurance. CASE REPORTS: We present seven cases in which the subjects were startled by an electrical shock (real or perceived) and injury was reported. Calculations of the current and path were used to allocate causality between the shock and a history of chronic disease or previous trauma. In all seven cases, our analysis suggests that no current was passed through the body. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Symptomology seen as corroborating may actually be confounding. Witness and survivor descriptions of electrical shocks are fraught with subjectivity and misunderstanding. Available current is usually irrelevant and overemphasized, such as stress on a 100-ampere welding source, which is orders of magnitude beyond lethal limits. History can also be biased for a number of reasons. Bayesian inference in multisensory perception can lead to a subject sincerely believing they had experienced an electrical shock. Determination of the current pathway and calculations of the amplitude and duration of the shock can be critical for understanding the limits and potential causation of electrical injury.

Life-changing or trivial: Electricians' views about electrical accidents.

BACKGROUND: It is well known that electrical accidents can cause physical injury. Less well known is that long-term consequences may include emotional and cognitive problems. OBJECTIVE: To explore electricians' experiences and perceptions of work-related electrical accidents, with focus on psychological short- and long-term consequences, including how contacts with health care services and the workplace were perceived. METHODS: Semi-structured interviews with 23 Swedish male electricians, aged 25- 68, who had experienced at least one electrical accident and reported residual sensory, musculoskeletal, cognitive or emotional symptoms. Data was analyzed by means of qualitative content analysis. RESULTS: Immediate emotional reactions included surprise, confusion, fear, anxiety, and anger; also long-term consequences were seen. Experiencing a no-let-go situation was particularly stressful. The cause of the accident, and questions about guilt and blame were central in the aftermath. Lack of knowledge and routine among health care professionals concerning electrical injury was reported, as well as lack of medical and psychological follow-up. CONCLUSIONS: For some informants, the accident had been a life-changing event, while for others it was an event of little importance. Adequate handling at the workplace, and from health care personnel, including follow-up, could facilitate rehabilitation and return to work.

Longitudinal changes in quality of life following ICD implant and the impact of age, gender, and ICD shocks: observations from the INTRINSIC RV trial.

PURPOSE: ICDs can improve survival in at-risk patients but no consensus exists with respect to their impact on health-related quality of life (QOL). Moreover, the data are unclear on QOL benefits in specific patient subgroups. We sought to analyze, in the INTRINSIC RV ICD trial population, health-related QOL longitudinally following ICD implant and consider impact of age, gender, and ICD shocks on QOL by employing a global measure of health-related QOL. METHODS: One thousand five hundred thirty patients had an ICD implanted. One week after implant (n = 1461), 988 patients were randomized to DDDR with AV search hysteresis (n = 502) or VVI (n = 486) programming. QOL data, using the SF-36 short form, were obtained for the 1461 patient cohort, irrespective of randomization status, at baseline and prospectively for 1 year following ICD implant. RESULTS: Longitudinal mixed-effect analyses revealed significant improvements from baseline across all SF-36 subscales and component scores for the overall study cohort. Women had a substantially lower QOL at baseline, although their improvement after implant was similar to men. Patients <50 years scored consistently worse at baseline but experienced the greatest QOL improvement versus other age groups. Patients with higher NYHA class, angina, and diabetes had greater QOL improvements. There was no significant difference in QOL between patients with and without ICD shocks. CONCLUSIONS: Our findings indicate that QOL was reportedly better post-implant and suggest that benefits associated with ICD implantation go beyond the direct treatment of arrhythmias, with benefits seen across genders and different age groups. These results further highlight that ICD implantation, in and of itself, does not reduce QOL.

Immediate and long-term psychological problems for survivors of severe pediatric electrical injury.

OBJECTIVE: To compare psychological difficulties experienced during the initial acute hospitalization and the last follow up visit for children with electrical injuries (EI) and children without electrical injuries (non-EI). We hypothesized that children with electrical burns would have different psychological outcomes. METHODS: This retrospective study compared emotional and cognitive functioning of EI patients and a matched group of survivors of other burns. RESULTS: Medical records of 67 patients with and without EI were reviewed. For the EI group, the mean age at injury was 12.6±3.9 years, the mean age at follow up was 15.5±4.6 years, and mean TBSA 32±21%. For the Non-EI group, the mean age at injury was 12.4±3.9 years, the mean age at follow up was 14.5±4.7 years, and mean TBSA 32±21.5%. During the acute hospitalization, a significant difference was found between the groups in the area of neuropathic pain (Chi-square tests p<0.011). Individuals with EI were more likely to have acute stress disorder/post-traumatic stress disorder as well as amnesia of the accident than the controls; however, this did not reach statistical significance. No differences were found between the groups in other psychological areas. Follow up information from the last documented psychology/psychiatric visit revealed an equal number of patients experienced anxiety disorders, depression, grief, behavioral problems, and cognitive difficulties. CONCLUSIONS: Some differences were evident between the groups immediately after injury; however, long term outcomes were similar.

Psychiatric Outcome Over a Decade After Electrical Injury: Depression as a Predictor of Long-Term Adjustment.

Electrical injury (EI) produces a variety of physical, cognitive, and emotional consequences. Psychiatric and neurocognitive symptoms may complicate survivors' psychosocial adjustment and ability to return to work. However, due to a paucity of longitudinal research, the long-term course of EI remains poorly understood. The purpose of this study was to investigate psychiatric and functional status in EI patients over a decade after injury. Fourteen EI patients who originally underwent baseline neuropsychological evaluation participated in this long-term follow-up. Participants completed a telephone survey of functional status, neuropsychological symptom checklist, and the Psychosocial Adjustment to Illness Scale Self-Report. Participants were grouped according to baseline Beck Depression Inventory (BDI) scores. After an average of 12.36 years postinjury, participants with elevated baseline BDI scores experienced difficulty across multiple domains of psychosocial adjustment at follow-up. This group was also less likely to return to work and exhibited a significant increase in psychological distress. EI results in significant chronic psychiatric complaints for many survivors. In the current sample, psychiatric sequelae of EI continue to persist over a decade after injury. Moreover, elevated baseline BDI scores predicted worse outcomes for vocational and psychosocial adjustment. Findings underscore the impact of emotional symptoms on recovery and need for specialized psychiatric intervention immediately following injury.

After the storm: the social relations of return to work following electrical injury.

In this study, we explored the experiences of 13 individuals who had suffered an electrical injury at work and had subsequently returned to work. In this article, we report on the social, institutional, and relational elements that workers perceived to influence return to work experiences and the provision of workplace accommodations. These elements included (a) worker resources, (b) job characteristics, (c) workplace setting, (d) injury elements, (e) workers' compensation context, and (f) supports and advocacy provided. We conclude that the availability and provision of supportive accommodations are influenced by a multiplicity of interrelated factors including the legitimacy of resulting impairments following electrical injury, institutional structures (e.g., compensation and health care systems), the social relations of work, and broader labor market and economic contexts. Those workers who were vulnerable because of factors such as employment circumstances or labor market conditions were often poorly supported when returning to work following electrical injury.

Programming implantable cardioverter-defibrillators in primary prevention: higher or later.

Defibrillator shocks, appropriate or not, are associated with significant morbidity, as they decrease quality of life, can be involved in depression and anxiety, and are known to be proarrhythmic. Most recent data have even shown an association between shocks and overall mortality. As opposed to other defibrillator-related complications, the rate of inappropriate and unnecessary shocks can (and should) be decreased with adequate programming. This review focuses on the different programming strategies and tips available to reduce the rate of shocks in primary prevention patients with left ventricular dysfunction implanted with a defibrillator, as well as some of the manufacturers' device specificities.

Psychological indices as predictors for phantom shocks in implantable cardioverter defibrillator recipients.

BACKGROUND: A phantom shock-the sensation of an implantable cardioverter defibrillator (ICD) discharge in the absence of an actual discharge-is a phenomenon that can occur in ICD patients. Little is known about the influence of psychological factors on the incidence of phantom shocks. We evaluated psychological correlates of phantom shocks 2 years post-ICD implant in a cohort of Dutch ICD recipients. METHODS: Consecutive patients (N = 300; 87.5% men; mean age = 62.3) willing to participate in a prospective study (Twente ICD Cohort Study) on psychological factors in ICD recipients received an ICD between September 2007 and February 2010. At baseline, patients complete the 36-item Short Form Health Survey, Hospital Anxiety and Depression Scale, and the Type D Scale. Lifetime presence of anxiety and depression was assessed with the MINI structural interview. RESULTS: During a follow-up of 24 months, 16 patients (5.4%) experienced a phantom shock. Median time to (first) phantom shock was 13 weeks (range 0-48 weeks). In univariable analysis, no significant relationships were found between clinical or psychological indices and the occurrence of phantom shocks, nor was there an association between phantom shocks and type D personality, symptoms of anxiety, or a history of anxiety and depression. CONCLUSIONS: Neither symptoms of anxiety and depression nor psychiatric history were associated with the occurrence of phantom shocks. Further studies using more explorative, qualitative research techniques are warranted to examine the correlates of phantom shocks.

Mood and cognition after electrical injury: a follow-up study.

Individuals who have experienced an electrical injury have been reported to demonstrate both acute and delayed cognitive and psychiatric symptoms. The present study assessed 20 electrically injured patients who underwent neuropsychological evaluations twice following their injury. Time since injury, time between assessments, and longitudinal mood changes were evaluated for their potential impact on simple and complex attention outcomes. As an overall group, there was little change over time from low average to average baseline attention/concentration performance. However, results indicated that longitudinal increases in depressive symptoms were consistently associated with poorer performance on a measure of simple and complex attention. Loss of consciousness, litigation status, baseline injury status (acute vs. post-acute), and time between evaluations were not significant predictors of changes in cognitive performance. Implications for the treatment of comorbid psychiatric issues and for future research on victims of electrical trauma are discussed.

Outcome of occupational electrical injuries among French electric company workers: a retrospective report of 311 cases, 1996-2005.

This study reviewed records of all electrical incidents involving work-related injury to employees Electricité de France (EDF) from 1996 through 2005 and analysed data for 311 incidents. The results are compared with 1231 electrical incidents that occurred during 1970-1979 and 996 incidents during 1980-1989. A total of 311 electrical incidents were observed. The medical consequences of electrical incident remain severe and particularly, the current fatality rate (3.2%) is similar to that recorded in the 1980s (2.7%) and 1970s (3.3%). Among individuals with non-fatal incidents, any change has occurred in the prevalence of permanent functional sequelae (23.6% in the 1970s vs. 27.6% in the 1980s and 32.5% currently). An increase in the incidence of neuropsychiatric sequelae (5.4% in the 1980s vs. 13% currently) has been observed and they are now the second most common type of sequelae after those directly related to burns. Among the neurological sequelae, peripheral nervous system disorders are the most common, as observed in the 1980s. Since the definition of post-traumatic stress disorder (PTSD) has changed between the two periods, we can only report that the current prevalence of PTSD is 7.6%. This study emphasises the need for specific management of neurological and psychological impairments after electrical injuries, including especially early recognition and initiation of effective treatment.

Long-term sequelae of electrical injury.

OBJECTIVE: To summarize the current evidence-based knowledge about the long-term sequelae of injuries from electrical current. QUALITY OF EVIDENCE: MEDLINE was searched for English-language articles published in the past 20 years using the following search terms: electrical, injuries, wound, trauma, accident, sequelae, long-term, follow-up, and aftereffects. For obvious reasons, it is unethical to randomly study electrical injury in controlled clinical trials. By necessity, this topic is addressed in less-rigorous observational and retrospective work and case studies. Therefore, the strength of the literature pertaining to the long-term sequelae of electrical injury is impaired by the necessity of retrospective methods and case studies that typically describe small cohorts. MAIN MESSAGE: There are 2 possible consequences of electrical injury: the person either survives or dies. For those who survive electrical injury, the immediate consequences are usually obvious and often require extensive medical intervention. The long-term sequelae of the electrical injury might be more subtle, pervasive, and less well defined, but can include neurologic, psychological, and physical symptoms. In the field of compensation medicine, determining causation and attributing outcome to an injury that might not result in objective clinical findings becomes a considerable challenge. CONCLUSION: The appearance of these consequences of electrical injury might be substantially delayed, with onset 1 to 5 or more years after the electrical injury. This poses a problem for patients and health care workers, making it hard to ascribe symptoms to a remote injury when they might not arise until well after the incident event.

Transient global amnesia associated with accidental high-frequency stimulation of the right hippocampus in deep brain stimulation for segmental dystonia.

We report on a 66-year-old woman with segmental dystonia treated with chronic bilateral deep brain stimulation of the globus pallidus internus, in whom accidental high-voltage, high-frequency stimulation induced an episode of transient global amnesia (TGA) via an electrode contact which was misplaced in the right hippocampus. A possible mechanism underlying this TGA episode may have been the inhibition of local neuronal activity or fiber activation by high current density via direct electrical stimulation of hippocampal structures. While a unifying etiology of TGA has not been proven so far, our case demonstrates a possible link between focal electrical stimulation of hippocampal structures and the full clinical picture of the syndrome.