Electrical burns in times of economic crisis: A new epidemiologic profile.

Electrical injuries and especially those of high voltage still remain a source of high morbidity. Over the past few years, a change in the epidemiologic profile of these lesions was noticed at the Vall d'Hebron University Hospital Burn Unit, corresponding to an increase in cases out of the legal framework. It is our aim to describe this particular subset, to determine the extent of their injuries and to understand the reason for their increased incidence. We think this was favoured by the rise in the unemployment rate, along with higher copper prices.

Electrical injuries--morbidity, outcome and treatment rationale.

Electrical injuries are unique with respect to low mortality rates, but very high rates of short- and long-term morbidity, and overall outcome. Controversy still exists regarding the advantages of one-stage debridement versus early serial debridement of necrotic tissue. The purpose of this study was a retrospective evaluation of treatment, morbidity and outcome in a group of patients with electrical injuries. Over a 13-year period 1992 patients were admitted with acute burns to our burn centre. Electrical injuries occurred in 129 (6.5 per cent) of these patients. There were 38 high-tension injuries and 91 low-tension injuries. The average age was 33.7 years (5 months to 63 years), with burn wounds ranging from 1 to 57 per cent total body surface area (mean 9.5 per cent). Ninety-four (72.9 per cent) of these injuries were work related, and most occurred in males (85 per cent). A total of 323 surgical procedures were performed on those 129 patients. An average of 0.48, surgical debridements per patient was necessary in the low-tension injury group and only three partial finger or toe amputations were necessary. In the high-tension group, 27 major limb amputations were performed after 2.3 debridements per patient, resulting in an overall major limb amputation rate of 35 per cent. The average length of stay was 22 days, and the cost of hospitalization ranged from $900 to $120 000 (mean !4,901). Significant long-term neurological deficits persisted in 73 per cent of patients at long-term follow-up (mean 4.5 years). Only 5.3 per cent of patients after high-voltage electrical injury were able to return to their premorbid job.

Electrocardiographic monitoring after electrical injury: necessity or luxury.

It has been common practice to perform routine electrocardiographic (EKG) monitoring of electrically burned patients for the first 24 hours following injury. Is this monitoring necessary, or is it a luxury based on remote probabilities? The records of 48 consecutive patients admitted with high-voltage (greater than 1,000 volts) electrical injuries were reviewed with respect to history of a cardiac event in the field, EKG abnormalities on admission, and the presence of cardiac arrhythmias during the first postinjury day. No serious arrhythmias occurred in any patients who had a normal EKG on admission. It was concluded that routine cardiac monitoring after a high-voltage injury should be individualized based on history of loss of consciousness, documentation of an arrythmia, or an abnormal EKG.