Electrical injuries in pediatric patients are uncommon but can be life-threatening and require efficient and effective identification and management. Injury severity is based on the characteristics of the electricity, the duration of contact with the electrical source, and the current’s pathway through the body. This issue discusses the specific threats posed by high-voltage, low-voltage, and lightning injuries. The various presentations are described, including burns, arrhythmias, respiratory arrest, cardiac arrest, blunt trauma from falls or blast events, rhabdomyolysis, tympanic membrane rupture, and altered mental status, among others. The most current literature is reviewed, and an evidence-based approach is provided for the diagnosis and management of electrical injuries in pediatric patients presenting to the emergency department.
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Following are the most informative references cited in this paper, as determined by the authors.
1. Consumer Product Safety Commission. National Electronic Injury Surveillance System (NEISS) Estimates Query Builder. Accessed November 15, 2021. (Government database)
4. American Burn Association. Burn incidence fact sheet: burn incidence and treatment in the United States: 2016. Accessed November 15, 2021. (Data from National Burn Repository)
9. * Böhrer M, Stewart SA, Hurley KF. Epidemiology of electrical and lightning-related injuries among Canadian children and youth, 1997-2010: a Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) study. CJEM. 2018;20(4):586-591. (Retrospective review; 1183 injuries) DOI: 10.1017/cem.2017.49
20. * Allorto N, Atieh B, Bolgiani A, et al. ISBI practice guidelines for burn care, part 2. Burns. 2018;44(7):1617-1706. (Practice guidelines) DOI: 10.1016/j.burns.2018.09.012
24. * Arnoldo BD, Purdue GF, Kowalske K, et al. Electrical injuries: a 20-year review. J Burn Care Rehabil. 2004;25(6):479-484. (Retrospective review; 700 patients) DOI: 10.1097/01.bcr.0000144536.22284.5c
35. * Chen EH, Sareen A. Do children require ECG evaluation and inpatient telemetry after household electrical exposures? Ann Emerg Med. 2007;49(1):64-67. (Systematic review; 7 articles from 1966-2007) DOI: 10.1016/j.annemergmed.2006.05.004
38. * Hansen SM, Riahi S, Hjortshøj S, et al. Mortality and risk of cardiac complications among immediate survivors of accidental electric shock: a Danish nationwide cohort study. BMJ Open. 2017;7(8):e015967. (Retrospective study; 11,462 patients) DOI: 10.1136/bmjopen-2017-015967
39. * Searle J, Slagman A, Maaß W, et al. Cardiac monitoring in patients with electrical injuries. An analysis of 268 patients at the Charité Hospital. Dtsch Arztebl Int. 2013;110(50):847-853. (Retrospective; 268 patients) DOI: 10.3238/arztebl.2013.0847
40. * McLeod JS, Maringo AE, Doyle PJ, et al. Analysis of electrocardiograms associated with pediatric electrical burns. J Burn Care Res. 2018;39(1):65-72. (Retrospective review; 86 patients) DOI: 10.1097/bcr.0000000000000591
58. Pinto DS, Clardy PF. Environmental and weapon-related electrical injuries. Accessed November 15, 2021. (Review article)
59. * Bailey B, Gaudreault P, Thivierge RL, et al. Cardiac monitoring of children with household electrical injuries. Ann Emerg Med. 1995;25(5):612-617. (Retrospective review; 141 patients) DOI: 10.1016/s0196-0644(95)70173-7
63. Joffe MD. Moderate and severe thermal burns in children: emergency management. Accessed January 15, 2021. (Review article)
90. * Barajas-Nava LA, López-Alcalde J, Roqué i Figuls M, et al. Antibiotic prophylaxis for preventing burn wound infection. Cochrane Database Syst Rev. 2013(6):CD008738. (Cochrane review; 36 randomized controlled trials, 2117 participants) DOI: 10.1002/14651858.CD008738.pub2
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Keywords: electrical injuries, pediatric electrical injuries, electrical burns, high-voltage, low-voltage, lightning, lightning strike, lightning injuries, TASER, conducted electrical weapons, CEW, oral commissure burns, labial artery hemorrhage, Lichtenberg figure, EKC, ECG, electrocardiogram, burns, total body surface area, TBSA, Lund-Browder Chart, prevention, burn center referral criteria
Kathryn Schissler, DO; Carla Pruden, MD, MPH, CHSE
Wendy C. Coates, MD; Rachel Long, DO
December 2, 2021
January 1, 2025
Date of Original Release: December 1, 2021. Date of most recent review: November 15, 2021. Termination date: December 1, 2024.
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