Study Of Pattern of Electrical Injury Cases at A Tertiary Health Care Centre -A Cross Sectional Study

Abstract

BACK GROUND AND OBJECTIVES: WHO has defined injury as ‘body lesion at the organic level resulting from acute exposure to energy (mechanical, thermal, electrical, chemical or radiant) interacting with the body in amounts or rates that exceed the threshold of physiological tolerance. Electrical burns are the fifth leading cause of death among workers. Electrical accidents are at rise although suicidal and homicidal cases have been reported even in rural India with advancement of technology indicating that appropriate preventive and safety measures are not being practiced religiously. Nearly all cases of electrical injury eventually involve litigation for negligence, product liability, or workman’s compensation. Electrical injuries represent a special type of thermal injury, with a pathophysiology depending on the voltage, current flow and resistance of the skin and also on several other factors including environment. The present cross-sectional study is undertaken with the objective of “Understanding the injuries caused by electricity with a socio-forensic perspective”. Thus, helpful in planning the safety measures and legal solutions. MATERIALS AND METHODS: Data was collected from patients of electrical injuries visiting casualty/OPD/wards, their medical records and autopsy reports in fatal cases from Oct 2012 to Dec 2013 at KLESs Dr. Prabhakar Kore Hospital and MRC, Belgaum, by universal sampling method. Informed expressed consent is taken and a pre-tested proforma specially designed for this purpose used for collecting the information. RESULTS: In the study adults constituted the bulk. Male victims formed the majority, and maximum were in the age group of 11-20 (30.23%) years followed by 21-30 (18.61%) years. Among the total cases, adults and children constituted, 67.44% and 32.56% respectively. 46.51% cases were seen in rainy season. 74.42% of victims sustained injuries during day time. 62.80% of victims belonged to occupation other than electrician/labour while 20.93% victims were electricians and 16.27% were labours. High voltage contact formed the bulk of the current source contributing to 76.74%. Victims from urban area constituted 32.66% and from rural area 67.44%. Work place victims constituted 41.86% followed by 39.54% at public place and 18.60% at home. 44.19% victims had both entry and exit wounds and 25.58% had only entry wound, while 30.23% of the cases showed no entry/exit wounds. Entry wound was present in 30 (69.77%) out of 43 cases. Out of them, 86.66% showed entry wound in upper extremities. Exit wound was seen in 19 (44.19%) out of 43 victims, out of them 78.95% showed exit wound on lower extremities. Total of 37.21% victims sustained mechanical injuries. Most common current source involved in causing mechanical injury being (87.5%) high voltage. Out of total victims, 40 (93.02%) had associated burn injuries, out of them 29 (72.50%) with less than 25% TBSA burn, 10 (25%) with 25 to 49% TBSA burn and only one (2.50%) with 50 to 74% TBSA burn. 4.65% of the victims were treated on OPD basis while 95.35% victims needed hospitalization. In relation to hospital stay, 34.88% for 1 - 10 days, 32.56% for 11 - 20 days, 9.30% for 21-30 days and 18.61% for more than 30 days., whereas surgical intervention was done in 55.81% of cases. Mortality rate is 6.98% (03 cases) with septicaemia as cause of death. The renal parameters (blood urea & serum creatinine) in 41 cases revealed a unique result as, increased blood urea in 03 (7.32%), decreased in 06 (14.63%), WNL(within normal limit) in 32 (78.05%); while decreased serum creatinine in 27 (65.85%), WNL in 14 (34.15%). INTERPRETATION AND CONCLUSION: In the present study, electrical injury cases constituted to 0.91% of the total medico-legal cases and were of unintentional; majority consisting of adult males, mortality rate of 6.98% and seen in high voltage electric contact, majority of patients’ hospital stay was 1-20 days. One case with 50 - 74% TBSA burn was recovered and discharged suggestive of internal electrical injuries more severe than visible external electrical burns. The path from upper limb to lower limb affects the renal parameters without serious external electrical injuries. As spot/instantaneous death cases may be taken to regional PHCs for autopsy/legal formalities instead of bringing to referral hospitals, the individual hospital statistics may not be the same when compared with general statistics.