title: Review of Adult Electrical Burn Injury Outcomes Worldwide: An Analysis of Low-Voltage vs High-Voltage Electrical Injury.
abstract: The aims of this article are to review low-voltage vs high-voltage electrical burn complications in adults and to identify novel areas that are not recognized to improve outcomes. An extensive literature search on electrical burn injuries was performed using OVID MEDLINE, PubMed, and EMBASE databases from 1946 to 2015. Studies relating to outcomes of electrical injury in the adult population (≥18 years of age) were included in the study. Forty-one single-institution publications with a total of 5485 electrical injury patients were identified and included in the present study. Fourty-four percent of these patients were low-voltage injuries (LVIs), 38.3% high-voltage injuries (HVIs), and 43.7% with voltage not otherwise specified. Forty-four percentage of studies did not characterize outcomes according to LHIs vs HVIs. Reported outcomes include surgical, medical, posttraumatic, and others (long-term/psychological/rehabilitative), all of which report greater incidence rates in HVI than in LVI. Only two studies report on psychological outcomes such as posttraumatic stress disorder. Mortality rates from electrical injuries are 2.6% in LVI, 5.2% in HVI, and 3.7% in not otherwise specified. Coroner's reports revealed a ratio of 2.4:1 for deaths caused by LVI compared with HVI. HVIs lead to greater morbidity and mortality than LVIs. However, the results of the coroner's reports suggest that immediate mortality from LVI may be underestimated. Furthermore, on the basis of this analysis, we conclude that the majority of studies report electrical injury outcomes; however, the majority of them do not analyze complications by low vs high voltage and often lack long-term psychological and rehabilitation outcomes after electrical injury indicating that a variety of central aspects are not being evaluated or assessed.
authors.affiliation: From the *Division of Plastic Surgery, Department of Surgery and †Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ‡Department of Immunology, University of Toronto, Ontario, Canada; and §Sunnybrook Research Institute, Toronto, Ontario, Canada.
authors.forename: Jessica G
authors.initials: JG
authors.lastname: Shih
authors.forename: Shahriar
authors.initials: S
authors.lastname: Shahrokhi
authors.forename: Marc G
authors.initials: MG
authors.lastname: Jeschke
mesh_terms: D000328:Adult; D001830:Body Surface Area; D002053:Burn Units; D002058:Burns, Electric / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D004560:Electricity / Q000009:adverse effects*; D005260:Female; D014943:Global Health; D006801:Humans; D015601:Injury Severity Score; D038622:Internationality; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D018434:Sickness Impact Profile; D016019:Survival Analysis; D017741:Survivors