Management of electrical burn injuries at Kenyatta National Hospital: a retrospective and prospective study
Njogu, Paul M
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Electrical burn injuries are on increase in developing countries. These injuries are associated with higher morbidity and higher rate of amputations than burns from other aetiologies. Predisposing factors to these injuries point to highly preventable injury. Pre- hospital care of burns in general by lay people in our set up can be inappropriate or even harmful. Management of electrical burn injuries includes rapid rescue, optimisation of patient then early aggressive serial debridement, reconstruction with grafts/ flaps and ultimately rehabilitation. These injuries are therefore costly to manage and have considerable long term complications. Devising preventive strategies remain the single most cost-effective method of reducing this burden. Despite the large number of international literature on electric burn injuries, there is limited information about these injuries in Africa and particularly locally. This study describes first aid care by general public, pattern, management, complications and outcome of electrical burn injuries in a cohort of patients managed at KNH between January 2005 and December 2009 (retrospective study) and between March to August 201 O(prospective study). Hypothesis: Electrical bum injury has high rate of morbidity and mortality, high rate of serial surgical debridement and reconstruction. The general public often provides inadequate and / or harmful first aid remedies to these victims. Objective: To evaluate predisposing factors, management and its outcome of electrical burn injuries in the retrospective arm of the study and in the prospective arm of the study, evaluate pre-hospital care, assess knowledge on first aid care and complications at presentation of electrical burn injuries at Kenyatta National Hospital Study design: combined retrospective (5 years) and prospective (6 months) study. Study population: Electrical burn injury patients. Methodology: , A retrospective analysis was conducted based on patient medical files retrieved from records department of 120 patients who consecutively presented with electrical burn injuries between January 2005 and December 2009 (retrospective arm of study). Prospective arm of study involved 30 patients who were consecutively attended at KNH between March and August 2010. Data analysis: Data was captured in a standardised questionnaire and analysed using SPSS Version 14 and MSExcel functions, describing the data by percentages, central tendency (median, mean) and measures of variability (such as standard deviation). Results: There were 30 consecutive patients in the prospective arm of the study and 120 patient medical files analysed in the retrospective arms of this study. There was 330% increase of electrical burn injuries over the 5 years under review. Both arms of the study showed that these injuries predominantly afflict the male sex with a male to female ratio of 10: 2.5. The young adult male of 21-40 years of age was particularly at risk with 50.8% and 76.7% in the retrospective and prospective arms of the study respectively being afflicted. These injuries occurred in densely populated areas. There were no incidences reported in association with lightning or direct current. Low voltage alternating current was responsible for 73.3% (n=120) and 63.3% (n=30) of incidences in the retrospective and prospective arms of the study respectively. High voltage alternating current was associated with 24% (n=29) of amputations i'n the retrospective arm of the study. Secondary injuries were observed in 9.2% and 13.3% of victims in the retrospective and prospective arms of study respectively. Incidences of arrhythmia and myo-/ haemoglobinuria were uncommon with 2.5% and 6.7% of incidences respectively in the retrospective arm of study. In the retrospective arm of study, upper limbs injuries constituted 48.5% (n=159) of the total number of injuries. of the total number of patients in the retrospective arm of the study, 64% (n=120) were managed non-operatively and had a mean duration of hospital stay of 6.1 days (SD5.5) and a median of 5 days. Surgical debridement and skin grafting were the commonest surgical operations done and both comprised 74.5% of all surgical operations in this arm of the study. The mean duration of hospital stay for these patients was 37.8 days (SD 30.0) and a median of 31.5 days. Complications during admission period (retrospective study) and at presentation 9prospective study) were common with the musculo- skeletal, sepsis and neurological complications being the commonest at 32.0%, 24.7% and 18.0% respectively of all complications in the retrospective arm of the study. The overall amputation rate was high at 24%. In the prospective arm of the study, 63.3% of patients received inappropriate or inadequate first aid care. Conclusion: Electrical burn injuries are on increase in our set up. They are predominantly affecting the males from densely populated areas mainly at their early stages of economic productivity. These injuries can be accompanied by life threatening secondary injuries as a result of fall or violent repulsion and this compounds the high morbidity associated with these injuries. Majority of these injuries can be managed non-operatively. Serial surgical procedures with a modest duration of hospital stay are to be expected. Complications are common particularly sepsis, soft tissue damage and neurological dysfunctions. Whereas these injuries are infrequent and highly preventable, once they occur, majority of the victims are highly likely to get inappropriate first aid care and are unlikely to reach KNH in good time.