title: Early predictors of myoglobinuria and acute renal failure following electrical injury.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Rosen
authors.forename: J N
authors.initials: JN
authors.lastname: Adler
authors.forename: J T
authors.initials: JT
authors.lastname: Rabban
authors.forename: R K
authors.initials: RK
authors.lastname: Sethi
authors.forename: L
authors.initials: L
authors.lastname: Arkoff
authors.forename: J A
authors.initials: JA
authors.lastname: Blair
authors.forename: R
authors.initials: R
authors.lastname: Sheridan
mesh_terms: 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