Electrical injuries: a 30-year review.

INTRODUCTION: Electrical injuries currently remain a world-wide problem. This study determines whether electrical injuries at our institution have changed in the past 30 years, and identifies electrical burn complications and any high-risk groups. METHODS: From 1967 to 1997, 185 children admitted to our institute were identified with electrical burns. Fifty-five percent of these electrical burns occurred from 1987 to 1997. RESULTS: During the last 10 years of this study, 43% of the electrical injuries (n = 44) were from low voltage (120-240 V) and 57% (n = 58) from high voltage (>1,000 V). In 17 children, serious low-voltage burns were identified as oral commissure burns. These were treated conservatively with one to two reconstructive procedures within 2 years. High-voltage injuries were mainly identified in male children (age 11 to 18 years). Thirty-three percent of high-voltage burns required amputation, 29% had deep muscle involvement, and 24% required either escharotomy or fasciotomy. No mortalities were reported. CONCLUSION: Although the incidence of low-voltage burns is currently on a steady decline, high-voltage injuries remain a problem, particularly in adolescent males.     

Management of acute calvarial burns in children

BACKGROUND: Although rare, head burns involving the calvarium are a serious complication of burns and electrical injury, and present therapeutic challenges to the surgical burn care team. We evaluated our experiences and compared available strategies to address this challenge. METHODS: Records of all burned children between January 1986 and December 2000 were reviewed. Twenty-seven children (15 boys and 12 girls) with scalp burns extending at least into the outer table of bone were identified and compared with a matched group of 30 patients admitted for acute thermal burns without skull injury. RESULTS: Flame burn was the injury mechanism in 78% of these patients and electrical injury was the injury mechanism in 22%. The incidence of calvarial burns in our patient population was 1.2% for thermal burns and 5.6% for electrical injuries during the study period. The age distribution was biphasic, with maximums in infancy for thermal burns and in puberty for electrical injuries. Eight of 27 patients (29.6%) developed full-thickness calvarial bone defects. In 23 patients, calvarial burn wound coverage was achieved with bone debridement and immediate or delayed placement of autograft skin. In four patients (all with electrical injury), local scalp flaps were required for closure. The length of hospital stay and overall number of acute operative procedures significantly increased for patients with calvarial burns. CONCLUSION: Acute calvarial burns are safely managed by bone debridement in combination with staged autografting or early flap coverage. Although flap coverage reduces the number of required procedures, the extensive wound size in thermal burns restricts acute flap procedures primarily to electrical injuries. Compared with patients without skull injury, length of hospital stay and the number of acute operative procedures are tremendously increased in patients with calvarial burns.     

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.     

Verbrennungsbehandlung von Kindern

BACKGROUND: A retrospective epidemiological multifactorial study of pediatric burn patients admitted to the Burn Center Bochum in the period of 1992-2002 was performed. METHODS: Data from 628 patients were analyzed and included age, sex, mortality, hospital stay, percent of total body surface area (TBSA) burned, localization of burns, number of surgical procedures, source of the burn as well as social standing of the families. RESULTS: The majority of patients (414) were between 0 and 3 years. The median age was 2.99. The median TBSA was 11.9%. There were 387 males (62%) and 241 females (38%, ratio of 1.6:1). The overall mortality rate was 1.4% (6/629). The main causes of injury were scald burns (435; 70%), followed by flame burns (153; 24%), electric injuries (17; 3%), and hot oil (21; 3%). Surgery was performed on 365 (58%) children. The others (263; 42%) were treated without surgery. DISCUSSION: The number of children with a background other than German was higher; moreover, a high number of injuries was not covered by health insurance. Having identified the high-risk group among the pediatric burn patients, we suggest that prevention programs should be directed towards these families in order to reduce further risk of pediatric burns.     

Acute electrical burns: a 10-year clinical experience

We have reviewed 113 cases of electrical burns treated at the Cook County Hospital Burn Center during the past 10 years. There were 3265 acute burn admissions during this period. the incidence of electrical burns being 3.5 per cent. Low-voltage electrical burns occurred in 82 of the 113 patients (73 per cent). These were caused mostly by household electricity supplies, occurred in children, and were preventable. Arc burns of the perioral region were allowed to heal spontaneously. The surgical management of other arc burns and flash burns was similar to that for most deep burn wounds. The incidence of high-voltage electrical injuries was 27 per cent in our series. Over 50 per cent of these injuries were not work-related. These tended to occur outside the home in young adult males and were also frequently preventable. None of these patients developed acute renal failure. Early surgical debridement of devitalized tissue with allografting, followed by delayed definitive wound closure or amputation prevented septic complications. Early fasciotomy appeared to have little effect on complete limb salvage. Limb loss continues to be the major factor contributing to the high morbidity associated with these injuries. All 113 patients survived. We attribute this to early transfer of patients to our Burn Unit, aggressive fluid resuscitation, continuous haemodynamic and metabolic support, and early surgical intervention.     

Economic burden of burn injuries in the Netherlands: A 3 months follow-up study

IntroductionBurn care has rapidly improved in the past decades. However, healthcare innovations can be expensive, demanding careful choices on their implementation. Obtaining knowledge on the extent of the costs of burn injuries is an essential first step for economic evaluations within burn care. The objective of this study was to determine the economic burden of patients with burns admitted to a burn centre and to identify important cost categories until 3 months post-burn.Patients and methodsA prospective cohort study was conducted in the burn centre of Maasstad Hospital Rotterdam, the Netherlands, including all patients with acute burn related injuries from August 2011 until July 2012. Total costs were calculated from a societal perspective, until 3 months post injury. Subgroup analyses were performed to examine whether the mean total costs per patient differed by age, aetiology or percentage total body surface area (TBSA) burned.ResultsIn our population, with a mean burn size of 8%, mean total costs were €26,540 per patient varying from €742 to €235,557. Most important cost categories were burn centre days (62%), surgical interventions (5%) and work absence (20%). Flame burns were significantly more costly than other types of burns, adult patients were significantly more costly than children and adolescents and a higher percentage TBSA burned also corresponded to significantly higher costs.Discussion and conclusionMean total costs of burn care in the first 3 months post injury were estimated at €26,540 and depended on age, aetiology and TBSA. Mean total costs in our population probably apply to other high-income countries as well, although we should realise that patients with burn injuries are diverse and represent a broad range of total costs. To reduce costs of burn care, future intervention studies should focus on a timely wound healing, reducing length of stay and enabling an early return to work.     

Characteristics of 1494 pediatric burn patients in Shanghai

To analyze the epidemiological characteristics of pediatric burn patients in Shanghai and to determine the targets for a pediatric burn prevention program, a retrospective review of all medical records of acute pediatric burn patients (age相似文献   

Electrical injury: a long-term analysis with review of regional differences

Due to its relatively small share among burn injuries, published data on electrical injuries remain scarce, and differ in patient collectives due to infrastructural differences. We have retrospectively analyzed records of 56 patients who were admitted because of electrical injury to our burn center from 1994 to 2008, compared results with the current literature, and focused our review on regional differences. Patients in our collective were predominantly young men (71%, n = 40/56) and those who resulted from work-related accidents (59%, n = 33/56). The mean total burn surface area was 26%. In all, 93% of patients needed at least 1 operation, with 43% of patients requiring at least 1 surgical intervention during a follow-up hospital stay. The mean length-of-stay was 44 days. Two patients died, accounting for a mortality rate of 3.6%. When comparing high to low-voltage injuries, patients in the former group were significantly younger, had more operations, and required a longer length-of-stay. With respect to work-related high-voltage injuries, job-specific male-predominance explains for the demographic distribution of admissions. Low-voltage injuries continue to have low mortality rates in this part of Europe, most likely as a result of established high security standards as well as access to emergency treatment with subsequent intensive and specialist surgical care.     

Retrospective evaluation of admission criteria for paediatric electrical injuries

In the medical community, the practice of admitting all electrical burns for 24–48 h of observation, monitoring and laboratory evaluation is widespread. This retrospective review of paediatric electrical burns was conducted to determine which patients may safely be treated as outpatients.

Retrospective analysis of all paediatric burns admitted between 1980 and 1991 identified 35 patients with electrical injuries. Patients were divided into two groups for analysis: those burned by exposure to household voltages (120–240 V; n=26) and those exposed to high voltages, in excess of 1000 V (n=9).

The majority of household electrical injuries occurred secondary to contact with the household 120 V (21/26). Contact with an extremity accounted for the largest number of these injuries (18/26). The mouth was the second most frequent site of injury (7/26). Most of these patients (20/26) had < 1 per cent BSA burn. No patient in the household-voltage group had an arrythmia that required treatment, nor were there any identified examples of compartment syndrome or other vascular complications. Seven patients did require minimal skin grafting. No deaths occurred in either group.

The patients in the household-voltage group were significantly younger. High-voltage electrical injuries occurred in an older patient population and required more aggressive care and surgical intervention. This was evident at the time of initial evaluation. Based on these data, healthy children with small partial-thickness electrical burns and no initial evidence of cardiac or neurovascular injury do not appear to need hospital admission.     

Assessment of a quality improvement intervention to improve the consistency of total body surface area burn estimates between referring facilities and a pediatric burn center

BackgroundBurns are a significant source of pediatric morbidity and frequently result in transfer of care to a pediatric burn center. Data suggest that referring facilities often overestimate the total body surface area (%TBSA) of burns in comparison to the subsequent assessment at the pediatric burn center. Such discrepancies may trigger inappropriately aggressive interventions with potential for patient harm. Our baseline assessment of data from 106 patients transferred to our pediatric burn center over a one-year period showed that 59/106 (56%) patients had a %TBSA recorded at the time of transfer and 18/59 (31%) had clinically significant differences (>5% difference) in estimates between the referring facility and the pediatric burn center.MethodsInformed by this clinical audit and a root cause analysis, we implemented practices to enhance consistency of clinical assessments between referring facilities and our pediatric burn center. These practices included the use of a common clinical assessment instrument (a standardized Lund and Browder form) that was integrated into the interfacility transfer process as well as educational outreach at referring facilities for providers who treat children with burns, prioritizing facilities with the highest number of discrepancies.ResultsFollow up data was reviewed 16–23 months after initiating the intervention. Cumulatively, we found significant improvement in the proportion of patients with %TBSA recorded (94% vs 56%, p < 0.001) that achieved our goal to exceed 90% and a reduction in clinically significant discrepancies that exceeded our goal of 15% (10% vs 31%, p = 0.002).ConclusionsReferring facilities often overestimate the %TBSA in comparison to the subsequent assessment at the pediatric burn center. The consistency of the %TBSA estimates can be improved by interventions that utilize the sharing of a common clinical assessment instrument and standardization of the transfer intake process.     

Work-related burn injuries in Ontario,Canada: has anything changed in the last 10 years?

BACKGROUND: Many burn injuries occur in the workplace. Previous research from this institution 10 years ago analyzed the incidence and nature of occupation-related burns admitted to our facility. PURPOSE: To compare the current incidence and patterns of work-related burn injuries treated at our adult regional burn center (Current group) with the findings of a similar study 10 years ago (Early group). METHODS: Retrospective study of all burn center admissions between 5 December 1998 and 31 December 2000 was completed. The data from the Early and Current groups was analyzed using the Chi-square test of homogeneity. RESULTS: During the study period, 355 patients were hospitalized. After exclusions, 100 occupational burn cases were identified (28%). The mean age of patients was 39+/-12 years, 90% were male. The mean total body surface area (TBSA) burn was 11+/-13.7%. The most common mechanism of burn was electrical (32%), followed by flame (22%), scald (17%), tar (14%), contact (8%), and chemical (7%). Four patients (4%) died of their injuries. There were no significant differences between the Current group and the Early group in terms of incidence, age, gender, occupation, mechanism of burn, or mortality. CONCLUSION: In the past 10 years no change was found in the incidence or pattern of work-related burn injuries treated at this institution. This suggests that existing prevention strategies have not been effective.     

A retrospective analysis of 1083 Turkish patients with serious burns

A total of 1083 burn cases hospitalised at a burn center between August 1988 and the end of 1997 were studied retrospectively to determine the factors and demographic features associated with burn injury in Turkey. The means for patient age and percent total body surface area (TBSA) burned were 18.1 years and 31.2%, respectively (medians were 14.0 years and 25.0%, respectively). Burn injuries were more common in winter and spring, and most occurred in the home. The majority of patients were city dwellers, and had been referred from public hospitals. There was a predominance of male patients (71.9%) in the study population, but the proportions of children and adults were equal. Almost half of the males and the majority of the females were children/students. The vast majority of female adults were housewives, and most of the men were employed outside the home. More than half of the patients suffered second-degree burns, and the others all had deeper burn injuries. The most frequent cause of burn in the study population was flame. Children mainly suffered from scalding, and adults from flame and electrical burns. There were no differences between the sexes regarding depth of burn; whereas percentage total burned surface area was higher in females. Children had a lower mean TBSA and lower rate of third-degree burns. Mortality rate of the study population was 33.5%. The study results identified various risk factors and the groups at high risk for serious burns and indicated some ways that prevention programmes can be improved.     

Patterns of grease burn injury: development of a classification system

Grease burns occur commonly in the home during food preparation. It has been our observation that grease burns follow a particular pattern of injury. The purpose of this study was to review our institutional experience in the management of these burns to develop a classification scheme. We performed a retrospective review of patients admitted to our burn center with grease burns. Subjects were identified through our database and their charts were reviewed with particular attention to burn distribution, TBSA and need for grafting. We excluded workplace burns and children under the age of six. A total of 249 patients who fit the above criteria were admitted with grease burns to our burn center from 1993 to 2003. The sequence of events leading to burn and its distribution followed a consistent pattern. The majority of patients (86%) had an isolated upper extremity burn or upper extremity burn in combination with a face, trunk or lower extremity burn. Forty percent of patients required at least one excision and grafting procedure. Grease burns associated with cooking at home follow predictable patterns of injury. Based on these patterns we proposed a classification system for domestic grease burns.     

Electrical burns: A retrospective analysis across a 5-year period

This study aims to review the experience, at an institution, with patients who suffered electrical burns and study the peculiar characteristics of this type of burn as well as its complications and epidemiological aspects. The study includes medical records of patients with electrical burns who were admitted to the Burn Unit of Hospital das Clínicas in São Paulo, Brazil, from November 2001 to October 2006. They were classified into four categories: high voltage (≥1000 V), low voltage (<1000 V), ‘flash burn’ (in which there is no electrical current flow through the body of the patient) and burns caused by lightning. The complications were more severe and common in the high-voltage group, while longer hospital stays and more complex surgical procedures due to the greater depth of burns were also observed in this group. High-voltage burns are mainly labour-/occupation-related. The majority of the patients were young men at the beginning of their professional lives. This factor generates an important socio-economic impact due to the high incidence of sequelae, resulting in amputations, rendering them unable to maintain their occupations.     

Burns with multiple trauma

The purpose of this study was to determine the incidence, mechanisms, and outcomes of management in patients with multisystem trauma and associated burn injury. A retrospective review was performed of patients admitted with combined burns and trauma from 1990 through 1999. Mechanism of injury, extent of burns, associated injuries, Injury Severity Score (ISS), and patient outcomes were identified. There were 2,845 burn and 19,418 trauma admissions. Fifty-six patients (2.0% and 0.29% respectively) had combined burns and trauma. Mean ISS was 21.7 and average percentage total body surface area was 16.2. Associated injuries included fractures in 32, complex soft-tissue injury in 20, head injury in 11, and abdominal trauma in seven. Mechanism of injury was industrial in 19, motor vehicle accident in 16, house fire in 13, high voltage in six, and other in three. Skin grafting was required in 33 of 56 patients (59%). Six of 56 patients died. Mean ISS was 19.0 in survivors compared with 46.2 in nonsurvivors. The combination of burns with multiple system trauma is uncommon. Fractures are the most frequent associated injury, and the majority of patients will require skin grafting in their burn treatment. Outcomes with appropriate management are favorable and are primarily dependent on the degree of associated trauma.     

A survey on 30 months electrical burns in Shiraz University of Medical Sciences Burn Hospital

Electrical burn is less common nowadays but still has complications and requires therapeutic interventions especially in developing countries. It occurs more in males and in industrial sites. The importance of electrical burn led us to study a 30 months history of electrical burn in Shiraz, Southern Iran. In a cross-sectional retrospective study, 1352 patients were surveyed for 30 months in relation to the cause, time, demographic information, therapeutic measures and prognosis of the electrical burn. Among burn patients, 4.73% were due to electrical burns (mean age, 30.5 years) and 95.3% were male. The mean hospitalization period was 11.5 days and the mean burn extent was 27.5%. Half of the victims were employees and 59.3% of the electrical burns occurred at their work site. 67.2% of burns were due to high voltage electrical current (more than 1000 V) and 4.6% of the patients died due to the direct cause of electrical burn. The high prevalence of electrical burn in males and workers emphasizes on the essence of standardization of occupational areas and use of trained workers to prevent electrical burns.     

Sink bathing burns: A unique opportunity for an injury prevention initiative

Sink-bathing is common practice among parents. However, this puts infants and young children at unrecognized risk for burn injuries. As the only verified pediatric burn center in a large urban area, we treat burn patients from a large variation in socioeconomic status. This provides us a unique opportunity to examine sink-burn injury patterns, circumstances surrounding these burns, identify areas with high incidence and put in place an injury prevention outreach initiative. This retrospective study included patients treated for sink-bathing burns at our burn center in an 8.5-year period. Analysis of 71 patients revealed infants under one year of age are most commonly afflicted. Additionally, that families of low-socioeconomic means are disproportionately affected. Understanding the different circumstances surrounding sink-bathing burns allows us to be more specific in our community education efforts and efficiently guide our resources.     

Electrical burns in sports fishing: A case report

Electrical burns are among the most devastating types of burns, with wide-ranging injuries. They can sometimes occur in the context of fishing, usually involving high voltages.The authors present the case of a 59-year-old-man who suffered a sports accident during a fishing competition, with the formation of an electrical arc due to proximity of the fishing rod and high voltage cables. He presented burns affecting 3% of TBSA, third degree deep burns on trunk and left hand; no signs of cardiac injury. He was admitted to our Burn Unit for monitoring, care dressing and surgical treatment; complete wound healing was achieved after 24 days.Due to its relatively small share among burns, published data on electrical injuries and fishing remain scarce, and differ in patient collectives due to infrastructural or environmental differences. The authors are not aware of published specific reports on electrical burns in sports fishing practice, like the case here presented.The authors want to alert for potential medical, social and economic consequences of this type of sports accidents that could be entirely avoidable with some preventive measures.     

Epidemiology and outcome of burns: Early experience at the country's first national burns Centre

This study aims to document the epidemiologic pattern and outcome of burn injuries in the country's first national burn centre. This case series study was conducted over a 2-year period at Burns Care Centre (BCC), Pakistan Institute of Medical Sciences (PIMS), Islamabad. The study included all burn injury patients who primarily presented to and were managed at the centre. Those patients who presented more than 24 h after injury or those who were initially managed at some other hospital were excluded from the study. Initial assessment and diagnosis was made by thorough history, physical examination and necessary investigations. Patients with major burns, high voltage electric burns and those needing any surgical interventions were admitted for indoor management. Patients with minor burns were discharged home after necessary emergency management, home medication and follow-up advice. The sociodemographic profile of the patients, site of sustaining burn injury, type and extent (total body surface area (TBSA), skin thickness involved and associated inhalational injury) of burn and outcome in terms of survival or mortality, etc., were all recorded on a proforma. The data were subjected to statistical analysis.