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ORIGINAL ARTICLE
Year : 2021  |  Volume : 29  |  Issue : 1  |  Page : 19-25

Epidemiological clinical profile and outcome of electric burn at our tertiary care center in Hadoti region


Department of General Surgery, Government Medical College, Kota, Rajasthan, India

Date of Submission03-Aug-2020
Date of Decision12-Aug-2020
Date of Acceptance08-Dec-2021
Date of Web Publication08-Jun-2022

Correspondence Address:
Dr. Vishal Kumar Neniwal
Department of General Surgery, Government Medical College, Kota, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijb.ijb_20_20

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  Abstract 


Introduction: The incidence of electrical accidents has increased due to the use of electricity in households, institutions, and industries. Electrical injury is a major cause of burn injury and significant cause of mortality, morbidity, and disability.
Materials and Methods: This prospective analytical study which was conducted in the department of surgery of our tertiary care center MBS hospital from July 2016 to June 2017. A total of 120 patients of electric burn were included in our study burn unit. We reviewed the following variables such as age, sex, occupation, socioeconomic status, mechanism of injury, body surface area involve, voltage, course at hospital stay, prognosis, and surgical modalities.
Results: There were 111 males and 9 females. Seventy-four electric injuries were due to high-tension line above 1000 V and remaining by household line. In 84% of patients, upper limbs were involved. Most of the patients were farmer and student who belong to farmer families and most were of the working age group. Twenty-three (19.17%) patients underwent major amputation due to extensive tissue and bone destruction. During the follow-up period, 22 patients had only the ability to perform their usual and daily activities and could not work at all.
Conclusions: Electric burns are preventable public health problem. Preventative strategies need to be put in place to decrease the incidence of electrical injuries. The prevention is possible by increasing awareness through primary education and advice precautions such as the use of insulated gloves and footwear.

Keywords: Electric burn, electric injury, epidemiology, prevention, voltage


How to cite this article:
Neniwal VK, Sharma RK, Meena A. Epidemiological clinical profile and outcome of electric burn at our tertiary care center in Hadoti region. Indian J Burns 2021;29:19-25

How to cite this URL:
Neniwal VK, Sharma RK, Meena A. Epidemiological clinical profile and outcome of electric burn at our tertiary care center in Hadoti region. Indian J Burns [serial online] 2021 [cited 2022 Jun 25];29:19-25. Available from: https://www.ijburns.com/text.asp?2021/29/1/19/346906




  Introduction Top


Electrical injuries are among the most important health problems worldwide and more in developing countries like India. Electric burn injuries are still associated with significant mortality and morbidity. Electric burns can be caused by either low-voltage or high-voltage currents. In our country, electric burn injuries continue to be a challenging problem due to poor medical facilities, lack of safety measures, lack of public awareness, poverty and illiteracy, poor substandard electrical wiring, increased exposure to potential hazards, and malpractices such as unqualified person do job without appropriate training, supervision and education regarding safety, and proper handling of electricity.

Electrical injuries represent a special type of thermal injury, with pathophysiology depending on the voltage, current flow, and resistance of the skin. High-voltage electric current has more irreversible localized and systemic consequences, with a high percentage of disability. Injuries due to contact with electricity most commonly involve utility workers, and there is also a high incidence among students and children because of playing in the ground where uncovered electric lines.[1] Household injuries from homemade equipment and repairs are very frequent. The effect of the electric current on the body is determined by the following factors: Type of current, amount of current, pathway of current, duration of contact, area of contact, and resistance of the body, and voltage.

In this study, we tried to identify and analyze the epidemiological characteristics along with clinical aspects and highlight the morbidity and mortality associated with electric burn injury in a tertiary care center and to identify prevention measures.


  Materials and Methods Top


This was a prospective analytical study conducted on 120 electric burn patients over a period of 1 year at our tertiary care center GMC Kota. Detailed clinical history and clinical examination were done for all patients. We reviewed all the patients with variables such as age, sex, occupation, socioeconomic status, mode of injury, time to admission, primary treatment received, body surface area involve, voltage, course at hospital stay, mortality, limb loss, and prognosis. The burn size was calculated by Lund and Browder chart. Some surgical procedures such as cleaning and dressing, skin temp application, fasciotomy, escharotomy, and debridement were done by clinical evaluation. The patients were treated by fluid resuscitations, continuous cardiac monitoring, and muscle enzymes. Mannitol and soda bicarbonate were used for the treatment of myoglobinuria. The cardiac evaluation was done by serial electrocardiography (ECG) monitoring. Minor amputations such as finger removal, toe disarticulation, and major amputations such as below knee, mid thigh, midforearm, arm and forequarter, and hindquarter were done after evaluating the exact vascular status by obtaining a Color Doppler or computed tomography angiography of the limbs and clear line of demarcation develop between viable and dead tissue, before subjecting the patient to the emotional trauma of disability. All patients were followed for a period of 1 year for their performance as healthy and return to work, wound healed, death or contracture lead to loss of limb function.

Statistical analysis was performed using the IBM SPSS version 25. IBM Company, IBM Corp. Armonk, New York. All the information on electric burn-related epidemiology was gathered with the help of a preform and predesigned schedule. The pro forma was translated into the local language. Written consent was taken from all patients and for the use of clinical details for the academic purpose. The study was conducted in adherence to the ethical guidelines of the Declaration of Helsinki and its amendments. The patients who refused to give consent or lost follow-up were excluded from this study. We confirm the availability and access of all original data reported in this study.


  Results Top


A total number of 120 patients of electric burn were included in our study, out of a total of 562 burn patients admitted to our institute from July 2016 to June 2017. Electric burn represented 21.35% which was quite significant when compared to other parts of the world. Our study consisted of 120 electric burn patients, of which 111 (92.5%) patients were male and 9 (7.5%) were female, likely because of occupational predisposition. The mean age of burn patients was 29 years with a range of 6–80 years. The most frequently hospitalized burn patients were in the age group of 21–30 years, which accounted for 39.19% of patients followed by 31–40 years (19.16%) and 11–20 years (19.16%) and the least number of burn patients (2.5%) above 60 years of age. The pediatric age group (0 − 10 years) was 6 (5%) patients, those all male sustained burn injury [Figure 1].
Figure 1: Age and sex distribution

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Around 62% (74) of patients were injured by high-tension line above 1000 V, and remaining patients were injured by household line below 1000 V. Most of them were adolescent and working age groups. Around 57% of patients were belonging from the rural background area.

Nearly 42% of the participants were admitted in the summer season (JuneAugust) followed by autumn season (September–November) 42 (35%) cases. Less number of patients (5%) was admitted during the winter season (December–February). The highest number of electric burn admissions was during July [Table 1]. The peak time of incidents took place between 9 a.m. and 12 p.m. followed by 6 a.m. and 9 a.m., with 42 cases (35%) and 37 cases (30.8%), respectively. The peak time of admission was 5 p.m. to 10 p.m. in our study.
Table 1: Presents a monthly admission of electric burn

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The majority of patients, 69 cases (57.5%) were farmer and student who belong to farmer families by occupation. Around 19 cases were unemployed and the reason may be due to female patients doing house job and pediatric and old age patients. Only seven patients were electrician and accidentally injured by electric burn rest all patients are not proper trend and educated on electricity-related work [Figure 2].
Figure 2: Occupation

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Most burn incident took place at field during work in farm (38%), where 35% of cases of them occurred inside the home at the time of household wire fitting. Most of the female cases occurred in the kitchen. All seven electricians involve in powerhouse of electricity during change electricity phase when accidentally electric injury occurs.

The mode of injury in our study was 79 patients (65.83%) had electrical injury while working with some electric supply-related work and 18 (15%) were due to earthing/rain and contact with electricity line during playing or working in the garden, 8 (6.67%) by contact with domestic current in the kitchen, 6 (5%) due to contact with electric wire or wire broken and fall over patients, 4 (3.34%) sustained electrical burns, while working on electric pole, had a fall from height with multiple bone fractures which were managed by orthopedician associated with burn management. We were found that five (4.16%) patients of electric injury during mobile charging [Figure 3]. Mechanism of electric burn, 75% of cases due to accidental touch to electric wire and remaining due to unaccepted current while working otherwise offline electricity.
Figure 3: Mode of injury

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In the present study, according to the total body surface area affected (TBSA), it was found maximum patients (54.16%) had TBSA 15%–30%, 13 patients had TBSA ≤ 15%. Where 19.17% of patients TBSA affected were 31%–50%. Among 13 (10.83%) burn victims was 51%−75% TBSA involve [Table 2]. The average body surface area affected was 26.4%. The most affected area was upper limbs (86.67%) followed by lower limbs (47.5%), after that trunk and face whereas the major affected area in our study [Figure 4].
Table 2: Frequency of the study variables in patients with electrical burns

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Figure 4: Body area involve

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Primary management was rendered before admission to our hospital from referral hospital in 77.5% of patients and remaining patients direct attend our tertiary care hospital. Vitals at the time of admission were stable mostly in 75% of cases, and no significant ECG changes were found in around 87% of patient at the time of admission. Mean hospital stay was <5 days in 50% of cases. The length of stay varied from 1 to 38 days, with the mean of 4.57 days, in the probability of length of stay, which was statistically significant. In case of third and fourth-degree burn were lengths of hospital staying longer. Burns induced by electrical current in entry points were mainly observed in the right upper extremities in 49.2% of cases, the left upper extremities were observed in 14 patients. Around 28 patients not show any entry wound. While electrical burns in exit wound were not otherwise specified in most of the patients.

In our study period, all patients' dressing were carried out with topical antimicrobials along with debridement of dead necrotic tissue done. Initial wound toileting was carried out for every patient, and all of them received tetanus toxoid irrespective of their prior vaccination status. Proper hydration along with maintaining fluid balance and intravenous antibiotics according to the culture sensitivity was used depending on the case to combat the infection. Twenty-seven patients underwent fasciotomies of the extremities to avoid further damage followed by debridement and regular dressings. Of the 120 patients with electric burns in our study, 42 patients (35%) underwent amputation. We had 19 patients with finger and toe gangrenous caused due to contact with high-voltage electric wire and domestic current to amputations and disarticulations. Twenty-three (19.17%) patients underwent major amputation due to extensive tissue and bone destruction after clear line of demarcation develop with evaluating the exact vascular status by obtaining a Color Doppler or CT angiography of the limbs [Figure 5]. Out of 23 major amputations were five cases of below knee, two cases of mid thigh, ten cases of forearm, two cases of both forearm, two cases of arm, one case of the left forefoot, and one forequarter amputation.
Figure 5: Events during the hospital stay

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In this study of 120 patients, there were seven mortalities (5.83%), with a mean age of 38.4 ± 10.6 years (range: 18 − 58 years). All mortality cases were male [Figure 6]. All of the seven mortality cases with full hospital records died of multiorgan failure and sepsis related to their extensive wounds and tissue damage. Around half of patients show average prognosis because of full recover with some complication develops. About 28 patients (23.34%) were show good prognosis during the follow-up period.
Figure 6: Prognosis

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Around 57.5% of patients could perform their previous job in a 1 − 3 year of follow-up period. About 18.34% of patients had to find another alternative job for a living and need further training for the new job because of contracture develop leads to the loss of normal limb function. However, 22 patients had only the ability to perform their usual and daily activities and could not work. Out of 22, two patients were disabled and did not even return to their personal activities due to the loss of both forearms [Figure 7].
Figure 7: Follow-up

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  Discussion Top


Electrical burns are relatively uncommon and associated with significant morbidity and mortality and long-term disability. Electrical injuries are categorized according to voltage.[1] Electrical burns represent 21.35% of all burn admissions to our burns center and are mostly accidental. It forms a considerable fraction when compared to the developed country of the world.[2] Our study presents an exceedingly high volume of electric burn patients in a single year compared to earlier studies. The high incidence of electrical burns may be the consequence of the poverty, illiteracy, and low socioeconomic level of the population, improperly insulated wires, poorly placed and managed electrical switches, illegal electrical connections, and repair work on the electricity grid done by nonprofessionals.[3] In our study, mostly farmer and student belong to farmer families, and this can be attributed to the lack of appropriate training, education, and experience with regard to safety and proper handling of electricity. This may also be due to improper equipment, education, and training. Human error can also be a factor, but proper training and education can reduce this problem.[4],[5] In our study, we found that the most common electric injury happened through a sudden contact with the electrical wire accidentally. It may be because of the lower level of safety standards in that environment in our area as compared to other developed country [Figure 8].
Figure 8: A 6-year-old male child of electric burn show exit wound in the right scapula

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Most of the patients in our study belong to working age group of 16 − 45 years, which is similar to the other studies.[3],[4],[5],[6],[7] The higher incidence of electric burn injury in working group is explained that they are most active group and exposed to electric wire at home or work. As compared to Patil et al., 84 patients with electrical injuries were analyzed from 2004 to 2009 to identify the causative and demographic risk factors. The age of patients ranged from 3 to 61 years and males accounted for 84.5%.[8] The current study also found that more electrical burns occurred in rural as compared to urban areas. The study by Rao et al.[9] who introduced that rural environment was more insecure than urban because of not observing safety precautions, untrained, and illiteracy. The more frequent electrical burn in summer months as compared to other seasons in this study may be due to during illegal cabling to not paying tariffs assigned to use cooling devices with economical problems.[10] On month-by-month basis, July followed by June month recorded the highest number of electric burn incidents in the present study because this month is hottest summer and more need for cooling devices [Figure 9].
Figure 9: A 34-year-old male of electric burn show compartment develops with the left forearm and hand gangrenous change develop

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Demographic data in our study suggested that maximum number of electric burn occurred at work and home. Working age group male population sustained burn at work or in fields from the uninsulated high-voltage wires. Electric burn patients, most (61.67%) injuries were high-voltage burns, which results in second, third, and fourth-degree injury. These patients are high risk of developing the eschar, compartment syndrome, necrosis involving limb and deeper tissue, which requires debridement, fasciotomy, and amputation. This explains the high morbidity and limb loss among the electric burn patient. Morbidity and mortality are largely affected by the particular type, duration, and voltage of electrical current involved in each exposure. Overall mortality is estimated to be 3%–15%.[11] There were 7 (5.83%) cases of mortality in our study.

The average body surface area affected was 26.4% in the present study, so in around half of the patients were total duration of hospital stay < 5 days. Duration of hospital stays longer found in those patients TBSA more than 30%, and these data comparable to other study.[12],[13],[14],[15] This study shows that in general, electrical current entry wound involves the upper extremities and mostly on the right side because most patients were right-handed.

Patients who involve with high-voltage electrical injury may have more complications, such as amputation, disability and contracture formation, neurologic symptoms, renal failure, inability to perform fine work activities, and physical and mental symptoms.[16],[17],[18] The quality of life and works of the patient were suffering post electric burn injuries. More patients have significant difficulty in returning to work. In our study, only 57.5% of patients are able to return to their previous employment and perform the same duties, and 24.17% of patients did not return to work at all. Other patients either took on modified duties with the same employer or find another alternative job for a living and need further training for the new job.

This epidemiological study reflects the importance of electrical burns in our country, where unfortunately, their incidence is increasing rapidly with high morbidity, disability, and mortality, probably due to the lack of knowledge, lack of safety measures, absence of public awareness, exposure to potential hazards and malpractices, lack of attention, and lack of government supervision. The people suffering from electrical burn were predominantly damaged by high-voltage electricity in our study, so burn prevention of this life-threatening event and the treatment of burns, if injuries are unavoidable. Accurate information about this issue must be conveyed to the population through print and electronic media and other appropriate communication channels. Public awareness through different communication channels and government programs should focus on the safety and proper management of electrical appliances. Health-care workers also educate the patients and relatives to use and misuse of electricity, and we must continue our attempts in public education.


  Conclusion Top


Electric burns are preventable public health problem. Preventative strategies need to be put in place to decrease the incidence of electrical injuries. These may include public awareness program on the dangers of electrical injuries, measures to decrease the trade of stolen electric wire cables as well as broader socioeconomic development and educate to decrease the incentives promoting electric wire theft. The prevention is possible by increasing the awareness through primary education and advice precaution such as the use of insulated gloves and footwear before handling of electric device. Print and electronic media should take active part for spreading awareness and an integrated, comprehensive, and need-based program must be there to seize the situation. It is suggested that proper training of personnel for handling the electrical devices and better warning signals will reduce the incidence of electrical burns significantly.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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