A voltage-based analysis of fluid delivery and outcomes in burn patients with electrical injuries over a 6-year period

A. N. Boyd, B. C. Hartman, Rajiv Sood, T. A. Walroth

Research output: Contribution to journalArticle

Abstract

Introduction: Electrical injuries are associated with significant morbidity for affected patients. While cardiac and surgical interventions have been extensively reported, no practice guidelines or studies have specifically addressed fluid delivery and associated outcomes of patients with electrical injuries. The study objective was to evaluate the differences in fluid delivery in patients with high (≥1000 V) and low (<1000 V) voltage electrical injuries. Methods: This retrospective, observational study included adult electrical injury patients admitted for acute care. Patients with reported voltages were classified into high and low voltage subgroups. Primary outcomes of fluid administration and urine output over the first 24 h after injury were assessed between subgroups. Secondary outcomes included renal, cardiac, surgical, and additional complications such as mortality, cost, and length of stay. Results: Data were analyzed in 36 patients with reported voltages, including 26 patients in the high and 10 patients in the low voltage subgroups. Patients in the high voltage subgroup had a statistically significant higher median (IQR) total IV fluid given [46.6 (22.4–61.9) vs. 22.5 (8.3–31.4) mL/kg, p = 0.033] in the first 24 h to achieve a similar urine output to the low voltage subgroup. The high voltage patients had higher rates of myoglobinuria, rhabdomyolysis, and creatinine kinase elevation. Patients in the high voltage vs. low voltage group had significantly longer median (IQR) length of stay (days) [11 (2–19) vs. 1 (1–6); p = 0.015] and higher cost of hospital stay [$124,608 (19,486–296,991) vs. $16,165 (12,409–69,659); p = 0.033]. Conclusions: These results reinforce the importance of assessing electrical injuries and obtaining a voltage to provide patient-specific care, as high voltage electrical injuries receive more fluid than estimated maintenance rates. This study is the first of its kind to characterize fluid given for high and low voltage electrical injuries and effects on patient outcomes.

Original languageEnglish (US)
JournalBurns
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Wounds and Injuries
Length of Stay
Urine
Myoglobinuria
Costs and Cost Analysis
Rhabdomyolysis
Practice Guidelines
Observational Studies
Creatinine
Patient Care
Phosphotransferases
Retrospective Studies
Maintenance
Morbidity
Kidney
Mortality

Keywords

  • Burn
  • Electrical injury
  • Fluid delivery
  • High voltage
  • Low voltage

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

A voltage-based analysis of fluid delivery and outcomes in burn patients with electrical injuries over a 6-year period. / Boyd, A. N.; Hartman, B. C.; Sood, Rajiv; Walroth, T. A.

In: Burns, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Introduction: Electrical injuries are associated with significant morbidity for affected patients. While cardiac and surgical interventions have been extensively reported, no practice guidelines or studies have specifically addressed fluid delivery and associated outcomes of patients with electrical injuries. The study objective was to evaluate the differences in fluid delivery in patients with high (≥1000 V) and low (<1000 V) voltage electrical injuries. Methods: This retrospective, observational study included adult electrical injury patients admitted for acute care. Patients with reported voltages were classified into high and low voltage subgroups. Primary outcomes of fluid administration and urine output over the first 24 h after injury were assessed between subgroups. Secondary outcomes included renal, cardiac, surgical, and additional complications such as mortality, cost, and length of stay. Results: Data were analyzed in 36 patients with reported voltages, including 26 patients in the high and 10 patients in the low voltage subgroups. Patients in the high voltage subgroup had a statistically significant higher median (IQR) total IV fluid given [46.6 (22.4–61.9) vs. 22.5 (8.3–31.4) mL/kg, p = 0.033] in the first 24 h to achieve a similar urine output to the low voltage subgroup. The high voltage patients had higher rates of myoglobinuria, rhabdomyolysis, and creatinine kinase elevation. Patients in the high voltage vs. low voltage group had significantly longer median (IQR) length of stay (days) [11 (2–19) vs. 1 (1–6); p = 0.015] and higher cost of hospital stay [$124,608 (19,486–296,991) vs. $16,165 (12,409–69,659); p = 0.033]. Conclusions: These results reinforce the importance of assessing electrical injuries and obtaining a voltage to provide patient-specific care, as high voltage electrical injuries receive more fluid than estimated maintenance rates. This study is the first of its kind to characterize fluid given for high and low voltage electrical injuries and effects on patient outcomes.",
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N2 - Introduction: Electrical injuries are associated with significant morbidity for affected patients. While cardiac and surgical interventions have been extensively reported, no practice guidelines or studies have specifically addressed fluid delivery and associated outcomes of patients with electrical injuries. The study objective was to evaluate the differences in fluid delivery in patients with high (≥1000 V) and low (<1000 V) voltage electrical injuries. Methods: This retrospective, observational study included adult electrical injury patients admitted for acute care. Patients with reported voltages were classified into high and low voltage subgroups. Primary outcomes of fluid administration and urine output over the first 24 h after injury were assessed between subgroups. Secondary outcomes included renal, cardiac, surgical, and additional complications such as mortality, cost, and length of stay. Results: Data were analyzed in 36 patients with reported voltages, including 26 patients in the high and 10 patients in the low voltage subgroups. Patients in the high voltage subgroup had a statistically significant higher median (IQR) total IV fluid given [46.6 (22.4–61.9) vs. 22.5 (8.3–31.4) mL/kg, p = 0.033] in the first 24 h to achieve a similar urine output to the low voltage subgroup. The high voltage patients had higher rates of myoglobinuria, rhabdomyolysis, and creatinine kinase elevation. Patients in the high voltage vs. low voltage group had significantly longer median (IQR) length of stay (days) [11 (2–19) vs. 1 (1–6); p = 0.015] and higher cost of hospital stay [$124,608 (19,486–296,991) vs. $16,165 (12,409–69,659); p = 0.033]. Conclusions: These results reinforce the importance of assessing electrical injuries and obtaining a voltage to provide patient-specific care, as high voltage electrical injuries receive more fluid than estimated maintenance rates. This study is the first of its kind to characterize fluid given for high and low voltage electrical injuries and effects on patient outcomes.

AB - Introduction: Electrical injuries are associated with significant morbidity for affected patients. While cardiac and surgical interventions have been extensively reported, no practice guidelines or studies have specifically addressed fluid delivery and associated outcomes of patients with electrical injuries. The study objective was to evaluate the differences in fluid delivery in patients with high (≥1000 V) and low (<1000 V) voltage electrical injuries. Methods: This retrospective, observational study included adult electrical injury patients admitted for acute care. Patients with reported voltages were classified into high and low voltage subgroups. Primary outcomes of fluid administration and urine output over the first 24 h after injury were assessed between subgroups. Secondary outcomes included renal, cardiac, surgical, and additional complications such as mortality, cost, and length of stay. Results: Data were analyzed in 36 patients with reported voltages, including 26 patients in the high and 10 patients in the low voltage subgroups. Patients in the high voltage subgroup had a statistically significant higher median (IQR) total IV fluid given [46.6 (22.4–61.9) vs. 22.5 (8.3–31.4) mL/kg, p = 0.033] in the first 24 h to achieve a similar urine output to the low voltage subgroup. The high voltage patients had higher rates of myoglobinuria, rhabdomyolysis, and creatinine kinase elevation. Patients in the high voltage vs. low voltage group had significantly longer median (IQR) length of stay (days) [11 (2–19) vs. 1 (1–6); p = 0.015] and higher cost of hospital stay [$124,608 (19,486–296,991) vs. $16,165 (12,409–69,659); p = 0.033]. Conclusions: These results reinforce the importance of assessing electrical injuries and obtaining a voltage to provide patient-specific care, as high voltage electrical injuries receive more fluid than estimated maintenance rates. This study is the first of its kind to characterize fluid given for high and low voltage electrical injuries and effects on patient outcomes.

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KW - Low voltage

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