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.

Examination of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) validity and substantive scales in patients with electrical injury.

Objective: Electrical injury (EI) is a distinct subtype of traumatic injury that often results in a unique constellation of cognitive sequelae and unusual sensory experiences due to peripheral nervous system injury that are uncommon in general medical/neurological populations and have been unexplored with the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). Method: This study examined performance patterns on MMPI-2-RF validity and substantive scales among 62 EI patients who underwent neuropsychological evaluation, of which 46 demonstrated valid symptom reporting and neurocognitive test performance via multiple independent validity indicators and were retained for analysis. Results: Valid EI patients scored significantly higher than the MMPI-2-RF normative sample on several validity scales with the largest effect sizes on F-r (Infrequent Responses), Fs (Infrequent Somatic Responses), FBS-r (Symptom Validity), and RBS (Response Bias), and ≥33% obtaining elevated scores on these scales per standard interpretive criteria. Review of item content on these scales revealed several reflect disturbances in sensation, physical functioning, and/or cognition that are not infrequent in this population. Further, MMPI-2-RF clinical profiles did not reveal generalized distress or noncredible over-reporting. Rather, similar to the MMPI-2, valid EI patients had a specific pattern related to physical/sensory symptoms and reduced positive emotions with elevations on restructured clinical (RC) scale 1 (somatic complaints), somatic/cognitive specific problem scales, and low positive emotions (RC2). Conclusions: Elevations on some MMPI-2-RF validity scale may capture some degree of actual EI sequela that neuropsychologists need to consider to prevent erroneously concluding that a credible EI patient is over-reporting when s/he is reporting bona fide, EI-related symptoms.

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.

Returning to work after electrical injuries: workers' perspectives and advice to others.

The objective of this study was to gain an understanding of workers' experiences with returning to work, the challenges they experienced, and the supports they found most beneficial when returning to work after a workplace electrical injury. Thirteen semistructured qualitative telephone interviews were conducted with individuals who experienced an electrical injury at the workplace. Participants were recruited from specialized burns rehabilitation programs in Ontario, Canada. Interviews were transcribed verbatim and thematic analysis used to analyze the qualitative interviews. Data regarding workers' demographics, injury events, and occupational categories were also gathered to characterize the sample.Participants identified three distinct categories of challenges: 1) physical, cognitive, and psychosocial impairments and their effects on their work performance; 2) feelings of guilt, blame, and responsibility for the injury; and 3) having to return to the workplace or worksite where the injury took place. The most beneficial supports identified by the injured workers included: 1) support from family, friends, and coworkers; and 2) the receipt of rehabilitation services specialized in electrical injury. The most common advice to others after electrical injuries included: 1) avoiding electrical injury; 2) feeling ready to return to work; 3) filing a Workplace Safety and Insurance Board injury/claims report;4) proactive self-advocacy; and 5) garnering the assistance of individuals who understood electrical injuries to advocate on their behalf. Immediate and persistent physical, cognitive, psychosocial, and support factors can affect individuals' abilities to successfully return to work after an electrical injury. Specialized services and advocacy were viewed as beneficial to successful return to work.

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.

Impact of posttraumatic stress disorder and depression on neuropsychological functioning in electrical injury survivors.

To examine neuropsychological functioning in survivors of electrical injury with posttraumatic stress disorder (PTSD) and depression. This was a prospective research study that was done in an outpatient clinic of a rehabilitation hospital. Thirty participants were recruited for the study between January 2008 and December 2010. All participants completed questionnaires measuring depression, PTSD, and a series of standardized psychometric measures of neuropsychological functioning. Domains tested included verbal and visual memory, attention, and executive functioning. A correlation analysis was performed to explore association between variables. Based on the level of PTSD symptoms, subjects were divided into three groups: no PTSD, subclinical PTSD, and PTSD, and a series of one-way analyses of variance were done to explore this association further. A series of analyses of covariance were done to control for depression. PTSD had a significant (P < .05) negative association with immediate verbal memory and immediate and delayed visual memory. Subjects with PTSD had significantly (P < .05) worse scores on immediate and delayed verbal memory and visual memory than those with subclinical PTSD or no PTSD. Measures of attention, working memory, and executive functioning were not significantly different between PTSD groups. When depression was introduced as a covariate, verbal and visual memory scores were not significantly different between PTSD groups. The findings suggest that there is a negative association between PTSD and cognitive performance that may be related to depression among those with electrical injury. A larger sample size is warranted to explore this further.

Diagnosis of long-term sequelae after low-voltage electrical injury.

The purpose of this study was to determine the efficacy of diagnostic tests and specialty consultations in aiding the diagnosis of long-term symptoms after low-voltage electrical injury (EI). A retrospective hospital chart review of low-voltage electrical-injured patients admitted to the outpatient burn clinic of a rehabilitation hospital was conducted (January 2002 to March 2006). Results of tests and specialty consultations were compared between patients with low-voltage contact injuries and patients with low-voltage flash injuries using Student's t-test and χ(2) with a P < .05 considered significant. Forty patients were treated for low-voltage EI, and all injuries occurred at work. Three patients were excluded due to lack of exact voltage documentation. Of the remaining 37 patients, there were 31 males (83.8%) and 6 females (16.2%) with a mean age of 36.7 ± 11.0 years and a mean TBSA of 7.7 ± 7.3%. Of 83 specialty consultations, the most frequents were psychology (38.6%), physiatry (21.7%), neurology (15.7%), and orthopedic (8.4%). Eighty percent of consultations were negative (no pathology). Patients with electrical contact injury had more specialty consultations (68.7 vs 31.3%, P = .003), especially neurology (21.1 vs 3.8%, P = .027), and more tests than patients with electrical flash injury (86.5 vs 13.5%, P < .001). Four (6.3%) CT scans and 14 (21.9%) magnetic resonance imaging scans were performed in electrical contact injury patients, but the majority of their results were negative (75 and 71.4%, respectively). Ultrasound, bone scan, and x-rays were negative: 80, 100, and 100%, respectively. Low-voltage electrical-injured patients are frequently referred for specialty consultations and tests, which are usually not effective to correlate their long-term symptoms with the initial EI.

Neurologic and musculoskeletal complications of burn injuries.

As more people survive burn injuries, there is an increasing focus on managing the complications of burn injuries with the ultimate goal of improving survivors' quality of life. Musculoskeletal and neurologic sequelae are significant complications of burn injury. Electrical injury is a subcategory of burns with multiple musculoskeletal and neurologic complications. Knowledge of these complications helps clinicians provide optimal long-term care for burn survivors and enables survivors to attain maximal recovery.

Electrical flash burns due to switchboard explosions in New South Wales--a 9-year experience.

PURPOSE: To document the incidence and outcome of flash burns due to electrical switchboard explosions presenting to Concord Hospital Burns Unit, from January 2000 to December 2008. METHODS: The Concord Hospital Burns Unit Database was reviewed for admissions due to electrical burns from January 2000 to December 2008. RESULTS: There were 119 electrical burns admitted during the study period, 20 of which were due to high voltage current. Ninety-nine others were low voltage injuries and included 37 cases of electrical burns due to low voltage electrical switchboard explosions. All of the electrical switchboard burns occurred in male electricians. Twenty-one of the 37 low voltage injuries required admission and 7 of them required skin grafting. The mean LOS was 9.95 days. Twenty cases suffered serious complications including major psychological problems and ocular injuries. CONCLUSIONS: Flash burns resulting from switchboard explosions account for a significant proportion of all electrical burns presenting to our institution. These burns may highlight deficits in taking safety precautions and the use of personal protection equipment. Despite the small area of injury the long term psychological sequelae were significant resulting in a delayed return to employment, and there was a high incidence of eye injuries. Additional efforts are therefore required towards the prevention of such injuries.

Long-term sequelae of low-voltage electrical injury.

In North America, electrical injuries result in approximately 20,000 emergency department visits every year. They are the most common form of occupationally related burn injury, and the fifth leading cause of occupational fatality in the United States. The purpose of this study was to determine the long-term sequelae of low-voltage electrical burn injuries. A retrospective hospital chart review was conducted among electrical burn patients, admitted to a regional adult burn centre or a rehabilitation hospital between January 1, 2002 and December 31, 2003, to find new symptoms documented at follow-up visits. Telephone interviews were conducted to a random sample of these patients to document symptoms that had occurred since the injury. Thirty-eight of 39 electrical patient charts were reviewed, one was excluded because of a lack of follow-up notes. There were 35 (92%) men and three (8%) women with a mean age (+/-SD) of 45.4 +/- 13.4 years, and 8.9 +/- 10.5% total body surface area. The majority (97.4%) were work-related injuries, most of them (58%) because of low-voltage (<1000 V), most frequently electrical flash burns (55%). Neurological (81.6%) and psychological (71%) symptoms were the most common sequelae. The most frequent neurological symptoms were numbness (42%), weakness (32%), memory problems (32%), paresthesia (24%), and chronic pain (24%). The most common psychological symptoms were anxiety (50%), nightmares (45%), insomnia (37%), and flashbacks (37%) of the event. There were more patients with numbness (19 vs 59%) and nightmares (25 vs 59%) in the low-voltage group. Patients with more neurological symptoms also have more psychological symptoms. Eleven patients interviewed, reported a high incidence of neurological (82%), general (54%), and psychological (54%) symptoms, which occurred at 5.3 months, 1.7 months, and 1.5 months, respectively, after the electrical injury (EI). Electrical injured patients experience many physical and psychological sequelae after their injuries. Many of these symptoms are nonspecific, and they often do not appear until several months after the injury. Low-voltage EI produced more frequent long-term sequelae than high-voltage injuries. Frequent patient monitoring and prompt intervention of progressive changes after EI may improve the physical, psychological, and psychosocial recovery of these patients.

Quality of life and return to work following electrical burns.

To investigate the psychosocial outcomes following electrical burns, a cross-sectional survey of electrical burn patients was done using three outcome tools: the Burn Specific Health Scale brief version (BSHS-B), the Coping with Burns Questionnaire (CBQ), and the Pain Patient Profile (P3). Questionnaires were mailed to electrical burn patients discharged from an adult regional burn centre, and also distributed to attendants of an electrical utility conference in Toronto. Twenty-six of 88 patients who were discharged from the regional burn centre during the study period with updated residential information were contacted and 14 (54%) completed the questionnaires. Twenty questionnaires were also distributed at the conference and 8 (40%) were completed; leaving a total of 22 (48%) patients for the study. The average patient age was 44.0+/-11.7 years; 21 (96%) were men, and the average time from injury to survey completion was 5.3+/-4.9 years. Five (23%) of the 22 patients returned to the same work duties, 10 (45%) changed duties, and 7 (32%) did not return to work. BSHS-B scores were low for all patients. Participants with high voltage burns (>1000 V) had worse sexuality scores (p<0.05), while those with larger burns (>10% TBSA) had worse physical scores (p<0.05). Patients surveyed >5 years from injury showed improvement in physical scores. CBQ scores indicated that optimism was the most commonly used coping strategy. P3 showed significant levels of emotional distress in all patients, with anxiety being more common in high voltage injuries (p<0.05). The data suggests that electrical burn patients may have a limited ability to return to work and an overall poor quality of life. Emotional distress is the dominant feature influencing long-term outcome in these patients. Further studies are warranted to validate these findings.

Self-reported quality of life after electrical and thermal injury.

Electrical injury patients (EI) often require more procedures and longer hospital stays than their thermal injury counterparts. We hypothesized that postinjury quality of life might be better in thermal injury patients (TIs) than in EI. Each EI recorded in our institution's TRACS trade mark /ABA registry between 1995 and 2000 was matched with a TI for age and TBSA involvement. We compared SF-36 scores of EI and TIs to evaluate quality of life. Age and TBSA injury were similar between groups. SF-36 results demonstrated no significant differences in self-reported quality of life indices. Return to full-time employment did not differ significantly between groups. EI and TIs do not differ significantly in quality of life after their burn injuries. Self-evaluated function for EI and TIs is comparable. Quality of life in both EI and TIs are above population means on many dimensions.

Electric burns: high- and low-tension injuries.

From January 1993 to December 1997, 179 patients with electrical injuries were admitted to our burn unit. There were 55 patients with high-tension injuries and 124 patients with low-tension injuries. A high incidence of amputation (42%) is one of the characteristic sequelae of high-tension injuries, but no patients in this group of burns died. Early and serial debridement of necrotic tissue is our treatment of preference. The patient needs extensive rehabilitation and psychiatric support.