Early predictors of myoglobinuria and acute renal failure following electrical injury.
Myoglobinuria-induced acute renal failure (ARF) is a potentially lethal consequence of electrical injury. We describe clinical variables that can predict the risk of myoglobinuria and ARF following electrical injury. This was a retrospective multivariate analysis of risk factors among electrically injured patients over a 26-year period. Urine myoglobin status was documented in 162 patients; 14% had myoglobinuria. No patient developed ARF. Multivariate modeling revealed that high-voltage exposure, prehospital cardiac arrest, full-thickness burns, and compartment syndrome were associated with myoglobinuria. Using a prediction rule defined as positive when a patient had > or = 2 risk factors yielded a sensitivity of 96% and negative predictive value of 99%. Electrical injury patients with myoglobinuria have little risk of developing ARF. A prediction rule can be used to screen out patients at low risk for myoglobinuria and identify high-risk patients who warrant early aggressive treatment and a more definitive myoglobin test.
Rosen
C L
CL
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Adler
J N
JN
Rabban
J T
JT
Sethi
R K
RK
Arkoff
L
L
Blair
J A
JA
Sheridan
R
R
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology; D000328:Adult; D000368:Aged; D002056:Burns / Q000150:complications; D003161:Compartment Syndromes / Q000150:complications; D004556:Electric Injuries / Q000150:complications*; D005260:Female; D006323:Heart Arrest / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009212:Myoglobinuria / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors