Electrical Burns Presenting to a Burn Specialty Center in India: Navigating a Public Health and Infrastructure Crisis

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In India, approximately 700,000 burn cases annually require hospital admission, with 140,000 fatalities. This study aims to analyze trends, clinical outcomes, and predictors of morbidity and mortality among patients with electrical burns admitted to a specialized burn center in India. We employed a retrospective cohort study design, reviewing the charts of 220 patients admitted with electrical burns from March 2022 to December 2023. Data collected included demographics, burn characteristics, treatment, and outcomes. Statistical analysis involved descriptive statistics, Wilcoxon Rank-Sum, Fisher’s exact test, logistic regression for mortality predictors, and linear regression for length of stay predictors. The median age of patients was 20 years, with 85.3% being male and a median weight of 28kg. The median TBSA was 15%, with 87.6% having deep burns. The most common burn regions were the upper limbs (71.7%), lower limbs (66.5%), and hands (55%). High voltage burns constituted 36.3% of cases. Prehospital first aid was administered to 68.1% of patients, and 62.5% underwent surgical intervention, with 23.9% requiring amputations. Complications occurred in 25.1% of cases, including sepsis (14.3%), cardiac arrhythmia (9.6%), and multiple organ dysfunction (8.4%), with an in-hospital mortality rate of 16.7%. TBSA > 30% significantly predicted mortality (OR: 2.1, p < 0.001), while mechanical debridement was associated with reduced mortality (OR: 0.73, p = 0.016). Prehospital first aid and the presence of deep burns were significant predictors of longer hospital stays. Electrical burns in India predominantly affect young males and result in severe outcomes. Preventive measures, public awareness, and improved prehospital care are essential to mitigate the impact of electrical burns. Enhanced public safety and targeted interventions are necessary to reduce the burden and improve patient outcomes in LMICs. Deep burns TBSA High voltage LMICs Figures Figure 1 Introduction Burn injuries impose a significant burden in low- and middle-income countries (LMICs), with a disproportionately higher incidence, morbidity, and mortality compared to high-income countries. 1 The death rate due to burns in LMICs is reported to be eleven times higher than in high-income countries, highlighting the severity of the impact of burn injuries in these regions. 2 The economic consequences of burn injuries are also substantial, with the global macroeconomic burden of burns disproportionately affecting LMICs. 3 Additionally, limited access to both preventative and therapeutic infrastructure worsens the consequences of these injuries. 4 With an estimated seven million cases reported annually, burn injuries in India are a major cause of morbidity and mortality. 5 Among these cases, approximately 700,000 individuals require hospital admission for burn injuries, and approximately 140,000 result in fatalities. 5 The burden of burn injuries in India is further exacerbated by the high prevalence of disability resulting from these incidents, with over 200,000 individuals suffering from disabilities due to burn injuries annually. 6 Despite advancements in burn care, the burden of burn injuries in India remains substantial, highlighting the importance of continued research and public health interventions to reduce the incidence and impact of burn injuries in the country. 7 With the advancement of technology and increased electricity usage, electrical burns have become more common, especially among individuals who are regularly exposed to electrical equipment. 8 These injuries can extend beyond the skin, affecting deeper structures such as fascia, muscles, tendons, blood vessels, nerves, bones, and articulations, leading to complex clinical presentations and long-term complications. 9 High-voltage electrical burns, defined as those equal to or exceeding a kilovolt, can cause especially deep burns with severe consequences, particularly in cases involving the head and face. 10 , 11 Such burns may lead to near-instantaneous multisystem organ failure and death. 12 The mechanisms of electrical burn injuries in India are diverse, with contact with overhead power lines being a common cause, especially among construction workers who face increased risks of severe complications and invasive procedures. 13 Investigations in densely populated southeast Asian settings such as Bangladesh have previously demonstrated that electrical burns may constitute approximately one-third of all burn injuries, with a reported incidence rate of 3.97 per 100,000 annually. 14 However, despite the rising incidence of electrical burns, relatively few studies have sought to assess the treatment and outcomes of electrical burn patients at specialized burn centers in India. The present study aims to analyze the trends of electrical burns among patients admitted to a burn specialty center in urban India, expanding on the broader context of electrical burn injuries in the country. By examining the epidemiological data and clinical outcomes of electrical burn cases, this study aims to offer valuable insights to guide evidence-based practices and policy decisions aimed at reducing the burden of electrical burns and enhancing the quality of care for affected individuals in India. Methods Study Design We employed a retrospective cohort study design to characterize the presenting mechanism, severity, and outcomes of electrical burns at one of India’s largest plastic surgery and burn centers. The present study sought to assess electrical burn presentation and treatment characteristics to describe morbidity and mortality predictors among electrical burn patients. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institute Ethics Committee for postgraduate research, AIIMS, New Delhi, with Ref. No. AIIMSA00910 / 21.03.2024 Data Collection A retrospective chart review was utilized to identify electrical burn patients presenting to a major urban burn center in India between the dates of March 2022 and December 2023. Inclusion criteria included all patients admitted for burn injuries with a confirmed mechanism of electrical burns. All patients with mechanisms other than electrical burns were excluded. Patient age, weight, and demographic information was recorded along with the mechanism of injury, electrical voltage (classified as either high voltage or low voltage), total body surface area (TBSA) burned, burn thickness, anatomical location of the burn, treatment course including prehospital first aid and preliminary hospital care, surgical intervention, complications, length of burn center stay, and disposition outcome. Burn thickness was classified as either superficial, including first degree (superficial) and superficial second degree (partial thickness) burns, or deep, including deep second degree (partial thickness) or third degree (full thickness) burns. The Lund and Browder chart was used to calculate TBSA at the time of admission to the burn center. 15 Data Analysis Data was compiled in Microsoft Excel and analyzed in R (version 4.3.1). Given nonparametric data distributions, median and interquartile range (IQR) were determined to be ideal measures of central tendency. Patients were stratified by gender and age into groups of male and female patients, as well as age groups into pediatric (0–18 years), young adult (19–35), adult (36–64), and senior (> 65) strata. A Wilcoxon Rank-Sum test was used to assess between group differences of continuous variables and Fisher’s exact test was used to assess between group differences of dichotomous variables. Multiple logistic regression was used to model predictors of mortality and the development of complications, while multiple linear regression was used to model predictors of length of stay. Results Patient Demographics: Over the course of the study period, 220 patients were admitted to the burn center with electrical burns. The median patient age at presentation was 20 years old (IQR: 9,30). The vast majority of patients were male (85.3%, n = 214). Pediatric males were the most frequently presenting demographic, followed by young adult males and adult males (Table I). The median patient weight was 28kg (IQR: 17.8, 48.5). Table I: Demographic Characteristics of Admitted Patients Age Female Male Total Pediatric (0–18) 25 (10.0%) 92 (36.7%) 117 (46.6%) Young Adult (18–35) 8 (3.2%) 87 (34.7%) 95 (37.8%) Adult (36–64) 3 (1.2%) 34 (13.5%) 37 (14.7%) Senior (> 65) 1 (0.4%) 1 (0.4%) 2 (0.8%) Total 37 (14.7%) 214 (85.3%) 251 (100.0%) Burn Characteristics: Admitted patients suffered a median TBSA burn of 15% (IQR: 10%, 30%) with a maximum TBSA observed of 95%. 87.6% (n = 220) of patients were admitted with deep burns. The most common anatomical burn regions were upper limbs (71.7%, n = 180), lower limbs (66.5%, n = 167), hands (55.0%, n = 138), anterior trunk (39.4%, n = 99), and face (36.7%, n = 92), though 88.4% of patients experienced burns to at least two anatomical locations (Figure I). 75.7% (n = 190) of burns were classified as personal accidents, 22.3% (n = 56) of burns were classified as work-related, and 1.2% (n = 3) were classified as assault. 36.3% (n = 91) of burns were known to be high voltage. Mandatory medicolegal action for additional investigation was deemed necessary by hospital counsel in 70.1% (n = 176) of cases. Treatment Characteristics: 68.1% (n = 171) of patients received some form of prehospital first aid prior to presentation, and 84.1% (n = 211) of patients received primary stabilization at a non-specialty center before being transferred to the burn care center. Median time from burn to presentation at the burn center was 13.6 hours (IQR: 4.1, 201.1). Upon presentation, 62.5% (n = 157) of patients received surgical intervention. Patients most frequently underwent mechanical operative debridement (52.6%, n = 132), followed by grafting, with 37.0% (n = 94) of patients undergoing split thickness skin grafting and 3.9% (n = 10) of patients receiving donor skin allografting. 23.9% (n = 60) underwent extremity amputation, with 13.9% (n = 35) undergoing below elbow amputation, 7.2% (n = 18) undergoing above elbow amputation, 6.8% (n = 17) undergoing shoulder disarticulation, 2.4% (n = 6) undergoing below knee amputation, and 0.8% (n = 2) undergoing above knee amputation. The rate of extremity amputation did not differ between high voltage and low voltage burns, with rates of 25.3% and 23.1%, respectively (p = 0.818). 8.8% (n = 22) of patients underwent amputation of at least one digit. 10.4% (n = 26) of patients received a delayed free flap repair of their burn site. Patients experienced complicated recovery courses in 25.1% (n = 63) of cases. Most frequent complications included sepsis (14.3%, n = 36), cardiac arrythmia (9.6%, n = 24), multiple organ dysfunction (8.4%, n = 21), and gangrene (8.0%, n = 20). Overall, in-hospital mortality was 16.7% (n = 42). Median length of stay for surviving patients was 21 days (IQR: 6.5, 49). Morbidity and Mortality Predictors: Multivariate logistic regression revealed TBSA > 30% to be a significant predictor of in-hospital mortality (OR: 2.1 [95CI: 1.7, 2.6], p < 0.001). Mortality rate for those with greater 30% TBSA burns was 64.0% while mortality rate for those with less than or equal to 30% TBSA burns was 5.0% (p < 0.001). Mechanical debridement was conversely a significant predictor of decreased in-hospital mortality (OR: 0.73 [95CI: 0.64, 0.94], p = 0.016). Mortality rate for those who underwent mechanical debridement was 3.0%, while the mortality rate for those who did not was 31.9% (p < 0.001). In-hospital mortality was not dependent on electrical burn voltage (p = 0.944) or burn thickness (p = 0.964) (Table II). Table II: Multivariate Logistic Regression of In-Hospital Mortality Covariate OR [95CI] P-value Prehospital First Aid 0.97 [0.75, 1.21] 0.712 Primary Treatment 1.15 [0.92, 1.46] 0.223 TBSA > 30% 1.91 [1.54, 2.38] < 0.001 Deep Burns 1.15 [0.89, 1.47] 0.964 High Voltage 0.99 [0.84, 1.17] 0.944 Mechanical Debridement 0.73 [0.64, 0.94] 0.016 *Regression controlled for age, gender, and weight Multivariate linear regression revealed the presence of deep burns (p = 0.042) and lack of prehospital first aid (p = 0.001) to be predictive of increased length of stay among surviving patients(Table III). Surviving patients with deep burns were admitted for a median of 22.0 days (IQR: 7.8, 52.3) while those with only superficial burns were admitted for a median of 9.0 days (IQR: 4.0, 22.5) (p < 0.001). Surviving patients who did not receive prehospital care were admitted for a median of 48.0 days (IQR: 6.8, 79.3) while those who received prehospital care were admitted for a median of 20.0 days (IQR: 6.5, 38.5) (p = 0.44). Point biserial correlation similarly revealed a significant association between prehospital care and length of stay ( r = 0.23, p = 0.007). Table III: Multivariate Linear Regression of Length of Stay Covariate B coefficient P-value Prehospital First Aid -32.85 0.001 Primary Treatment 12.71 0.102 TBSA > 30% -9.74 0.570 Deep Burns 17.40 0.042 High Voltage 11.45 0.149 *Regression controlled for age, gender, and weight Discussion The findings of this study underscore the substantial burden of electrical burns in urban India, particularly among young male patients. The predominance of pediatric and young adult patients suggests a demographic at heightened risk, possibly due to increased exposure to electrical hazards. Similarly, the significant number of personal accidents compared to work-related incidents further demonstrates our findings that electrical burn injuries are not merely an occupational hazard. As such, our findings elucidate the need for increased public awareness and safety measures in domestic environments, as well as intervention for youth education regarding the dangers of electrical burns in urban Indian settings. Similar programs have been proposed in India to address the high morbidity and mortality burden of flame burns, though generalized uptake remains limited, further underscoring the need for re-investment in a growing public safety concern. 16 – 18 These findings are not unique to the Indian setting, as investigations from other LMICs worldwide pose pediatric populations at notable risk for electrical burns. 19 – 22 As it pertains to electrical burns, prevention programming may include electrical safety risk assessments of public infrastructure as well as legislation promoting regulatory enforcement of safety codes. 23 , 24 Previous studies have identified key characteristics of high electrical injury risk in pediatric populations pertaining to public infrastructure, such as those children living in outdoor settings near exposed power lines. 25 And while as recently as June 2024, the Indian Ministry of Power launched the “Electrical Safety Handbook for Students,” there remains a dearth of research investigating the impact of such interventions in urban Indian settings. 26 The high incidence of deep burns and extensive TBSA involvement highlights the severity of electrical burn injuries compared to other burn etiologies, as consistently described in prior literature. 22 , 27 The upper and lower limbs were the most affected anatomical regions of patients in our study, reflecting the nature of electrical injuries, which often occur due to direct contact with electrical sources. Rates of amputation appeared notably elevated compared to those seen in other burn etiologies; however, an amputation rate of 23.9%, as noted in our study, is within the range of previously reported figures in cases of electrical injury, though such figures vary widely from 3–40%. 13,21,28–30 Of note, high-voltage burns were not associated with higher rates of amputation than low-voltage burns, a notable departure from prior reports, which indicate high-voltage burns to be a predictor of amputation. 13 , 28 – 30 Also in contrast with prior literature, the present study suggests that the presence of high-voltage burns is not associated with either in-hospital morbidity or mortality compared to low-voltage burns. 13 , 28 – 30 The lack of correlation between observed mortality and burn voltage may be attributable to the high rate of prehospital mortality associated with electrical burns, which was not captured in our study. The management of electrical burns in our study population involved significant surgical interventions, including debridement, grafting, free flaps, and amputations. Aggressive mechanical debridement appears to be a protective factor for patient mortality, and, as such, emergent surgical exploration and debridement should be undertaken in all suitable patients with suspected soft tissue damage following electrical burn injury. 31 , 32 Complications like sepsis, cardiac arrhythmia, and multiple organ dysfunction were prevalent in our cohort, contributing to a high in-hospital mortality rate of 16.7%. The identification of TBSA > 30% as a significant predictor of in-hospital mortality is consistent with expectations of burn survivability, highlighting the critical impact of burn extent on patient outcomes. 33 Interestingly, our findings suggest that the depth of burns was not a significant predictor of mortality, influencing only the length of admission. This indicates that the total surface area affected by burns in electrical injuries may be a more crucial determinant of survival than burn thickness. We also demonstrate that prehospital first aid improves patient outcomes, as shown by a more than two-fold decrease in total hospital stay. Such drastic reductions highlight the importance of prehospital care development, which has been shown to reduce injury mortality by 25% in LMICs. 34 Thus, in addition to preventative interventions, including burn education and civil infrastructure management, the present study supports public investment into early treatment interventions such as emergency medical services. Given the lack of access to advanced burn care facilities in many parts of India, enhancing prehospital transportation services may also significantly improve patient outcomes. In our study, the observed mortality rate for patients who underwent mechanical debridement was 3.0%, compared to a mortality rate of 31.9% for those who did not undergo the procedure. However, as per our unit policy, we only perform surgical procedures—debridement and reconstruction—on patients who are not moribund and are in stable condition for the surgical procedure. Consequently, patients who were deemed non-survivable did not undergo debridement procedures. The present study is not without limitations. Data in this study was collected from a single burn center in urban India, which may limit its generalizability to more rural settings. Our study also did not investigate the specific prehospital interventions employed for burn resuscitation, an area meriting further research. Similarly, we did not investigate the effect of burn mechanism or voltage on out-of-hospital mortality, which may impact mortality predictors as they are described in the present study. Future research endeavors should focus on prospective studies of electrical burn patients to further elucidate the determinants of outcomes and evaluate the effectiveness of targeted preventative and reactionary interventions in reducing the burden of electrical burn injuries in LMIC settings. Conclusions Our study highlights the significant burden of electrical burns in urban India, particularly among young male patients. The findings emphasize the need for targeted public awareness campaigns and safety measures, especially in domestic settings where personal accidents predominate. The high incidence of severe burns and amputations underscores the critical nature of these injuries, necessitating immediate and aggressive surgical interventions to improve patient outcomes. Our study also underscores the importance of prehospital care, which markedly reduces hospital stays and improves survival rates. The evidence calls for a multifaceted approach, including public education, infrastructure safety assessments, and enhanced emergency medical services, to mitigate the impact of electrical burns. Future research should focus on evaluating the effectiveness of these interventions in urban Indian settings to further refine and implement strategies aimed at reducing the incidence and severity of electrical burns. Declarations The authors declare that no funds, grants, or other support were received during the preparation of this manuscript The authors have no relevant financial or non-financial interests to disclose Clinical Trial number is not applicable Informed consent was obtained from all individual participants included in the study. The authors affirm that human research participants provided informed consent for data publication. Author Contribution A- Shivangi Saha; B- Zachary J Eisner; C- Neeraj Kumar; D- Nandini Singh Tanwar; E- Anjali Chandola; F- Maneesh Singhal1. Study conceptualization: F, A, B2. Data Curation: C, D, E3. Formal Analysis: A, B, C, F4. Funding acquisition- None5. Investigation: A, B, C, F6. Methodology: C, D, E7. Project Administration: A.B.F 8. Supervision: A, B, F9. Validation: A, B, C10.Writing original draft: A, B, C, F11. Writing review and editing: D, EAll authors reviewed the results and approved the final version of the manuscript. References Nkenguye W (2024) Beyond burns: illuminating the unseen battle within – navigating the psychological fallout. Int J Surg Glob Health 7(2). 10.1097/GH9.0000000000000426 Outwater AH, Ismail H, Mgalilwa L, Justin Temu M, Mbembati NA (2013) Burns in Tanzania: morbidity and mortality, causes and risk factors: a review. Int J Burns Trauma 3(1):18–29 Gerstl JVE, Ehsan AN, Lassarén P et al (2024) The Global Macroeconomic Burden of Burn Injuries. 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J Trauma Acute Care Surg 73(1):261–268. 10.1097/TA.0b013e31824bde1e Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6498074","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":457220173,"identity":"08376588-1a9f-4d8e-b7d5-81453f0906c1","order_by":0,"name":"Shivangi Saha","email":"","orcid":"","institution":"All India Institute of Medical Sciences, New Delhi, India","correspondingAuthor":false,"prefix":"","firstName":"Shivangi","middleName":"","lastName":"Saha","suffix":""},{"id":457220174,"identity":"731ef7c0-a19b-44f5-b9bb-78eb277cdc4d","order_by":1,"name":"Zachary J Eisner","email":"","orcid":"","institution":"University of Michigan–Ann Arbor","correspondingAuthor":false,"prefix":"","firstName":"Zachary","middleName":"J","lastName":"Eisner","suffix":""},{"id":457220175,"identity":"5ad01786-4649-49da-8945-573b6ab5a96f","order_by":2,"name":"Neeraj Kumar","email":"","orcid":"","institution":"All India Institute of Medical Sciences, New Delhi, India","correspondingAuthor":false,"prefix":"","firstName":"Neeraj","middleName":"","lastName":"Kumar","suffix":""},{"id":457220177,"identity":"8048f6a1-75d9-411e-9a60-d53fb3fb57ee","order_by":3,"name":"Nandini Singh Tanwar","email":"","orcid":"","institution":"All India Institute of Medical Sciences, New Delhi, India","correspondingAuthor":false,"prefix":"","firstName":"Nandini","middleName":"Singh","lastName":"Tanwar","suffix":""},{"id":457220178,"identity":"189af6e1-b7c2-47b5-80c3-ed504edb9bdc","order_by":4,"name":"Anjali Chandola","email":"","orcid":"","institution":"All India Institute of Medical Sciences, New Delhi, India","correspondingAuthor":false,"prefix":"","firstName":"Anjali","middleName":"","lastName":"Chandola","suffix":""},{"id":457220180,"identity":"57893486-f1ce-4815-8786-3bed6923e57c","order_by":5,"name":"Maneesh Singhal","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYDCCA1DagL0BRFqQooUHxDKQIEWLRAKIIkIL3+3TiZ8LKmzszSWfX93wo0CCgb+9OwGvFslzuZulZ5xJS9w5O6fsZg/QYRJnzm7Aq8XgDO8Gad62wwkGt3PSbvAAtRhI5BLUsvk377//9gY3z6Td/EOklm3SvA0HGDfcYD92myhbJIFarHmOJSduOJPDdlvGQIKHoF/4gA67zVNjZ29w/Pizm2/+2Mjxt/fi14IEeAzAJLHKQYD9ASmqR8EoGAWjYAQBACvJSjGJFvqOAAAAAElFTkSuQmCC","orcid":"","institution":"All India Institute of Medical Sciences, New Delhi, India","correspondingAuthor":true,"prefix":"","firstName":"Maneesh","middleName":"","lastName":"Singhal","suffix":""}],"badges":[],"createdAt":"2025-04-21 17:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6498074/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6498074/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83023468,"identity":"94226f80-0d9b-4f5b-91e4-efc76a7b8d56","added_by":"auto","created_at":"2025-05-19 07:55:55","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":153660,"visible":true,"origin":"","legend":"\u003cp\u003eAnatomical Distribution of Electrical Burn Injuries\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6498074/v1/ea01a83f10443a4b75ce9028.jpeg"},{"id":83025033,"identity":"7a066487-bdcf-46c9-b4c4-491a950ba779","added_by":"auto","created_at":"2025-05-19 08:11:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":650007,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6498074/v1/ceccd021-d7f1-410b-8552-de39390ffbd5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Electrical Burns Presenting to a Burn Specialty Center in India: Navigating a Public Health and Infrastructure Crisis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBurn injuries impose a significant burden in low- and middle-income countries (LMICs), with a disproportionately higher incidence, morbidity, and mortality compared to high-income countries.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The death rate due to burns in LMICs is reported to be eleven times higher than in high-income countries, highlighting the severity of the impact of burn injuries in these regions.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The economic consequences of burn injuries are also substantial, with the global macroeconomic burden of burns disproportionately affecting LMICs.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Additionally, limited access to both preventative and therapeutic infrastructure worsens the consequences of these injuries.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWith an estimated seven million cases reported annually, burn injuries in India are a major cause of morbidity and mortality.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Among these cases, approximately 700,000 individuals require hospital admission for burn injuries, and approximately 140,000 result in fatalities.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e The burden of burn injuries in India is further exacerbated by the high prevalence of disability resulting from these incidents, with over 200,000 individuals suffering from disabilities due to burn injuries annually.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Despite advancements in burn care, the burden of burn injuries in India remains substantial, highlighting the importance of continued research and public health interventions to reduce the incidence and impact of burn injuries in the country.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWith the advancement of technology and increased electricity usage, electrical burns have become more common, especially among individuals who are regularly exposed to electrical equipment.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e These injuries can extend beyond the skin, affecting deeper structures such as fascia, muscles, tendons, blood vessels, nerves, bones, and articulations, leading to complex clinical presentations and long-term complications.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e High-voltage electrical burns, defined as those equal to or exceeding a kilovolt, can cause especially deep burns with severe consequences, particularly in cases involving the head and face.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Such burns may lead to near-instantaneous multisystem organ failure and death.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e The mechanisms of electrical burn injuries in India are diverse, with contact with overhead power lines being a common cause, especially among construction workers who face increased risks of severe complications and invasive procedures.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Investigations in densely populated southeast Asian settings such as Bangladesh have previously demonstrated that electrical burns may constitute approximately one-third of all burn injuries, with a reported incidence rate of 3.97 per 100,000 annually.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e However, despite the rising incidence of electrical burns, relatively few studies have sought to assess the treatment and outcomes of electrical burn patients at specialized burn centers in India.\u003c/p\u003e \u003cp\u003eThe present study aims to analyze the trends of electrical burns among patients admitted to a burn specialty center in urban India, expanding on the broader context of electrical burn injuries in the country. By examining the epidemiological data and clinical outcomes of electrical burn cases, this study aims to offer valuable insights to guide evidence-based practices and policy decisions aimed at reducing the burden of electrical burns and enhancing the quality of care for affected individuals in India.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eWe employed a retrospective cohort study design to characterize the presenting mechanism, severity, and outcomes of electrical burns at one of India\u0026rsquo;s largest plastic surgery and burn centers. The present study sought to assess electrical burn presentation and treatment characteristics to describe morbidity and mortality predictors among electrical burn patients. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institute Ethics Committee for postgraduate research, AIIMS, New Delhi, with Ref. No. AIIMSA00910 / 21.03.2024\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eA retrospective chart review was utilized to identify electrical burn patients presenting to a major urban burn center in India between the dates of March 2022 and December 2023. Inclusion criteria included all patients admitted for burn injuries with a confirmed mechanism of electrical burns. All patients with mechanisms other than electrical burns were excluded. Patient age, weight, and demographic information was recorded along with the mechanism of injury, electrical voltage (classified as either high voltage or low voltage), total body surface area (TBSA) burned, burn thickness, anatomical location of the burn, treatment course including prehospital first aid and preliminary hospital care, surgical intervention, complications, length of burn center stay, and disposition outcome. Burn thickness was classified as either superficial, including first degree (superficial) and superficial second degree (partial thickness) burns, or deep, including deep second degree (partial thickness) or third degree (full thickness) burns. The Lund and Browder chart was used to calculate TBSA at the time of admission to the burn center.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData was compiled in Microsoft Excel and analyzed in R (version 4.3.1). Given nonparametric data distributions, median and interquartile range (IQR) were determined to be ideal measures of central tendency. Patients were stratified by gender and age into groups of male and female patients, as well as age groups into pediatric (0\u0026ndash;18 years), young adult (19\u0026ndash;35), adult (36\u0026ndash;64), and senior (\u0026gt;\u0026thinsp;65) strata. A Wilcoxon Rank-Sum test was used to assess between group differences of continuous variables and Fisher\u0026rsquo;s exact test was used to assess between group differences of dichotomous variables. Multiple logistic regression was used to model predictors of mortality and the development of complications, while multiple linear regression was used to model predictors of length of stay.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePatient Demographics:\u003c/h2\u003e \u003cp\u003eOver the course of the study period, 220 patients were admitted to the burn center with electrical burns. The median patient age at presentation was 20 years old (IQR: 9,30). The vast majority of patients were male (85.3%, n\u0026thinsp;=\u0026thinsp;214). Pediatric males were the most frequently presenting demographic, followed by young adult males and adult males (Table I). The median patient weight was 28kg (IQR: 17.8, 48.5).\u003c/p\u003e \u003cp\u003eTable I: Demographic Characteristics of Admitted Patients\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePediatric (0\u0026ndash;18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92 (36.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e117 (46.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYoung Adult (18\u0026ndash;35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87 (34.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95 (37.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdult (36\u0026ndash;64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (13.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37 (14.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenior (\u0026gt;\u0026thinsp;65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (14.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e214 (85.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e251 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eBurn Characteristics:\u003c/h2\u003e \u003cp\u003eAdmitted patients suffered a median TBSA burn of 15% (IQR: 10%, 30%) with a maximum TBSA observed of 95%. 87.6% (n\u0026thinsp;=\u0026thinsp;220) of patients were admitted with deep burns. The most common anatomical burn regions were upper limbs (71.7%, n\u0026thinsp;=\u0026thinsp;180), lower limbs (66.5%, n\u0026thinsp;=\u0026thinsp;167), hands (55.0%, n\u0026thinsp;=\u0026thinsp;138), anterior trunk (39.4%, n\u0026thinsp;=\u0026thinsp;99), and face (36.7%, n\u0026thinsp;=\u0026thinsp;92), though 88.4% of patients experienced burns to at least two anatomical locations (Figure I). 75.7% (n\u0026thinsp;=\u0026thinsp;190) of burns were classified as personal accidents, 22.3% (n\u0026thinsp;=\u0026thinsp;56) of burns were classified as work-related, and 1.2% (n\u0026thinsp;=\u0026thinsp;3) were classified as assault. 36.3% (n\u0026thinsp;=\u0026thinsp;91) of burns were known to be high voltage. Mandatory medicolegal action for additional investigation was deemed necessary by hospital counsel in 70.1% (n\u0026thinsp;=\u0026thinsp;176) of cases.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTreatment Characteristics:\u003c/h3\u003e\n\u003cp\u003e68.1% (n\u0026thinsp;=\u0026thinsp;171) of patients received some form of prehospital first aid prior to presentation, and 84.1% (n\u0026thinsp;=\u0026thinsp;211) of patients received primary stabilization at a non-specialty center before being transferred to the burn care center. Median time from burn to presentation at the burn center was 13.6 hours (IQR: 4.1, 201.1).\u003c/p\u003e \u003cp\u003eUpon presentation, 62.5% (n\u0026thinsp;=\u0026thinsp;157) of patients received surgical intervention. Patients most frequently underwent mechanical operative debridement (52.6%, n\u0026thinsp;=\u0026thinsp;132), followed by grafting, with 37.0% (n\u0026thinsp;=\u0026thinsp;94) of patients undergoing split thickness skin grafting and 3.9% (n\u0026thinsp;=\u0026thinsp;10) of patients receiving donor skin allografting. 23.9% (n\u0026thinsp;=\u0026thinsp;60) underwent extremity amputation, with 13.9% (n\u0026thinsp;=\u0026thinsp;35) undergoing below elbow amputation, 7.2% (n\u0026thinsp;=\u0026thinsp;18) undergoing above elbow amputation, 6.8% (n\u0026thinsp;=\u0026thinsp;17) undergoing shoulder disarticulation, 2.4% (n\u0026thinsp;=\u0026thinsp;6) undergoing below knee amputation, and 0.8% (n\u0026thinsp;=\u0026thinsp;2) undergoing above knee amputation. The rate of extremity amputation did not differ between high voltage and low voltage burns, with rates of 25.3% and 23.1%, respectively (p\u0026thinsp;=\u0026thinsp;0.818). 8.8% (n\u0026thinsp;=\u0026thinsp;22) of patients underwent amputation of at least one digit. 10.4% (n\u0026thinsp;=\u0026thinsp;26) of patients received a delayed free flap repair of their burn site.\u003c/p\u003e \u003cp\u003ePatients experienced complicated recovery courses in 25.1% (n\u0026thinsp;=\u0026thinsp;63) of cases. Most frequent complications included sepsis (14.3%, n\u0026thinsp;=\u0026thinsp;36), cardiac arrythmia (9.6%, n\u0026thinsp;=\u0026thinsp;24), multiple organ dysfunction (8.4%, n\u0026thinsp;=\u0026thinsp;21), and gangrene (8.0%, n\u0026thinsp;=\u0026thinsp;20). Overall, in-hospital mortality was 16.7% (n\u0026thinsp;=\u0026thinsp;42). Median length of stay for surviving patients was 21 days (IQR: 6.5, 49).\u003c/p\u003e\n\u003ch3\u003eMorbidity and Mortality Predictors:\u003c/h3\u003e\n\u003cp\u003eMultivariate logistic regression revealed TBSA\u0026thinsp;\u0026gt;\u0026thinsp;30% to be a significant predictor of in-hospital mortality (OR: 2.1 [95CI: 1.7, 2.6], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Mortality rate for those with greater 30% TBSA burns was 64.0% while mortality rate for those with less than or equal to 30% TBSA burns was 5.0% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Mechanical debridement was conversely a significant predictor of decreased in-hospital mortality (OR: 0.73 [95CI: 0.64, 0.94], p\u0026thinsp;=\u0026thinsp;0.016). Mortality rate for those who underwent mechanical debridement was 3.0%, while the mortality rate for those who did not was 31.9% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In-hospital mortality was not dependent on electrical burn voltage (p\u0026thinsp;=\u0026thinsp;0.944) or burn thickness (p\u0026thinsp;=\u0026thinsp;0.964) (Table II).\u003c/p\u003e \u003cp\u003eTable II: Multivariate Logistic Regression of In-Hospital Mortality\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR [95CI]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrehospital First Aid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.97 [0.75, 1.21]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.712\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.15 [0.92, 1.46]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTBSA\u0026thinsp;\u0026gt;\u0026thinsp;30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.91 [1.54, 2.38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep Burns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.15 [0.89, 1.47]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.964\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Voltage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.99 [0.84, 1.17]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.944\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMechanical Debridement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.73 [0.64, 0.94]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.016\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*Regression controlled for age, gender, and weight\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMultivariate linear regression revealed the presence of deep burns (p\u0026thinsp;=\u0026thinsp;0.042) and lack of prehospital first aid (p\u0026thinsp;=\u0026thinsp;0.001) to be predictive of increased length of stay among surviving patients(Table III). Surviving patients with deep burns were admitted for a median of 22.0 days (IQR: 7.8, 52.3) while those with only superficial burns were admitted for a median of 9.0 days (IQR: 4.0, 22.5) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Surviving patients who did not receive prehospital care were admitted for a median of 48.0 days (IQR: 6.8, 79.3) while those who received prehospital care were admitted for a median of 20.0 days (IQR: 6.5, 38.5) (p\u0026thinsp;=\u0026thinsp;0.44). Point biserial correlation similarly revealed a significant association between prehospital care and length of stay (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.23, p\u0026thinsp;=\u0026thinsp;0.007).\u003c/p\u003e \u003cp\u003eTable III: Multivariate Linear Regression of Length of Stay\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB coefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrehospital First Aid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-32.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTBSA\u0026thinsp;\u0026gt;\u0026thinsp;30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-9.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.570\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep Burns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.042\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Voltage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.149\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*Regression controlled for age, gender, and weight\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study underscore the substantial burden of electrical burns in urban India, particularly among young male patients. The predominance of pediatric and young adult patients suggests a demographic at heightened risk, possibly due to increased exposure to electrical hazards. Similarly, the significant number of personal accidents compared to work-related incidents further demonstrates our findings that electrical burn injuries are not merely an occupational hazard. As such, our findings elucidate the need for increased public awareness and safety measures in domestic environments, as well as intervention for youth education regarding the dangers of electrical burns in urban Indian settings. Similar programs have been proposed in India to address the high morbidity and mortality burden of flame burns, though generalized uptake remains limited, further underscoring the need for re-investment in a growing public safety concern.\u003csup\u003e\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e These findings are not unique to the Indian setting, as investigations from other LMICs worldwide pose pediatric populations at notable risk for electrical burns.\u003csup\u003e\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e As it pertains to electrical burns, prevention programming may include electrical safety risk assessments of public infrastructure as well as legislation promoting regulatory enforcement of safety codes.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Previous studies have identified key characteristics of high electrical injury risk in pediatric populations pertaining to public infrastructure, such as those children living in outdoor settings near exposed power lines.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e And while as recently as June 2024, the Indian Ministry of Power launched the \u0026ldquo;Electrical Safety Handbook for Students,\u0026rdquo; there remains a dearth of research investigating the impact of such interventions in urban Indian settings.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe high incidence of deep burns and extensive TBSA involvement highlights the severity of electrical burn injuries compared to other burn etiologies, as consistently described in prior literature.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e The upper and lower limbs were the most affected anatomical regions of patients in our study, reflecting the nature of electrical injuries, which often occur due to direct contact with electrical sources. Rates of amputation appeared notably elevated compared to those seen in other burn etiologies; however, an amputation rate of 23.9%, as noted in our study, is within the range of previously reported figures in cases of electrical injury, though such figures vary widely from 3\u0026ndash;40%.\u003csup\u003e13,21,28\u0026ndash;30\u003c/sup\u003e Of note, high-voltage burns were not associated with higher rates of amputation than low-voltage burns, a notable departure from prior reports, which indicate high-voltage burns to be a predictor of amputation.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Also in contrast with prior literature, the present study suggests that the presence of high-voltage burns is not associated with either in-hospital morbidity or mortality compared to low-voltage burns.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e The lack of correlation between observed mortality and burn voltage may be attributable to the high rate of prehospital mortality associated with electrical burns, which was not captured in our study.\u003c/p\u003e \u003cp\u003eThe management of electrical burns in our study population involved significant surgical interventions, including debridement, grafting, free flaps, and amputations. Aggressive mechanical debridement appears to be a protective factor for patient mortality, and, as such, emergent surgical exploration and debridement should be undertaken in all suitable patients with suspected soft tissue damage following electrical burn injury.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e Complications like sepsis, cardiac arrhythmia, and multiple organ dysfunction were prevalent in our cohort, contributing to a high in-hospital mortality rate of 16.7%. The identification of TBSA\u0026thinsp;\u0026gt;\u0026thinsp;30% as a significant predictor of in-hospital mortality is consistent with expectations of burn survivability, highlighting the critical impact of burn extent on patient outcomes.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Interestingly, our findings suggest that the depth of burns was not a significant predictor of mortality, influencing only the length of admission. This indicates that the total surface area affected by burns in electrical injuries may be a more crucial determinant of survival than burn thickness.\u003c/p\u003e \u003cp\u003eWe also demonstrate that prehospital first aid improves patient outcomes, as shown by a more than two-fold decrease in total hospital stay. Such drastic reductions highlight the importance of prehospital care development, which has been shown to reduce injury mortality by 25% in LMICs.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e Thus, in addition to preventative interventions, including burn education and civil infrastructure management, the present study supports public investment into early treatment interventions such as emergency medical services. Given the lack of access to advanced burn care facilities in many parts of India, enhancing prehospital transportation services may also significantly improve patient outcomes. In our study, the observed mortality rate for patients who underwent mechanical debridement was 3.0%, compared to a mortality rate of 31.9% for those who did not undergo the procedure. However, as per our unit policy, we only perform surgical procedures\u0026mdash;debridement and reconstruction\u0026mdash;on patients who are not moribund and are in stable condition for the surgical procedure. Consequently, patients who were deemed non-survivable did not undergo debridement procedures.\u003c/p\u003e \u003cp\u003eThe present study is not without limitations. Data in this study was collected from a single burn center in urban India, which may limit its generalizability to more rural settings. Our study also did not investigate the specific prehospital interventions employed for burn resuscitation, an area meriting further research. Similarly, we did not investigate the effect of burn mechanism or voltage on out-of-hospital mortality, which may impact mortality predictors as they are described in the present study. Future research endeavors should focus on prospective studies of electrical burn patients to further elucidate the determinants of outcomes and evaluate the effectiveness of targeted preventative and reactionary interventions in reducing the burden of electrical burn injuries in LMIC settings.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur study highlights the significant burden of electrical burns in urban India, particularly among young male patients. The findings emphasize the need for targeted public awareness campaigns and safety measures, especially in domestic settings where personal accidents predominate. The high incidence of severe burns and amputations underscores the critical nature of these injuries, necessitating immediate and aggressive surgical interventions to improve patient outcomes. Our study also underscores the importance of prehospital care, which markedly reduces hospital stays and improves survival rates. The evidence calls for a multifaceted approach, including public education, infrastructure safety assessments, and enhanced emergency medical services, to mitigate the impact of electrical burns. Future research should focus on evaluating the effectiveness of these interventions in urban Indian settings to further refine and implement strategies aimed at reducing the incidence and severity of electrical burns.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose\u003c/p\u003e\n\u003cp\u003eClinical Trial number is not applicable\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003eThe authors affirm that human research participants provided informed consent for data publication.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA- Shivangi Saha; B- Zachary J Eisner; C- Neeraj Kumar; D- Nandini Singh Tanwar; E- Anjali Chandola; F- Maneesh Singhal1. Study conceptualization: F, A, B2. Data Curation: C, D, E3. Formal Analysis: A, B, C, F4. Funding acquisition- None5. Investigation: A, B, C, F6. Methodology: C, D, E7. Project Administration: A.B.F 8. Supervision: A, B, F9. Validation: A, B, C10.Writing original draft: A, B, C, F11. Writing review and editing: D, EAll authors reviewed the results and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNkenguye W (2024) Beyond burns: illuminating the unseen battle within \u0026ndash; navigating the psychological fallout. Int J Surg Glob Health 7(2). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/GH9.0000000000000426\u003c/span\u003e\u003cspan address=\"10.1097/GH9.0000000000000426\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOutwater AH, Ismail H, Mgalilwa L, Justin Temu M, Mbembati NA (2013) Burns in Tanzania: morbidity and mortality, causes and risk factors: a review. Int J Burns Trauma 3(1):18\u0026ndash;29\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGerstl JVE, Ehsan AN, Lassar\u0026eacute;n P et al (2024) The Global Macroeconomic Burden of Burn Injuries. 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J Trauma Acute Care Surg 73(1):261\u0026ndash;268. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/TA.0b013e31824bde1e\u003c/span\u003e\u003cspan address=\"10.1097/TA.0b013e31824bde1e\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Deep burns, TBSA, High voltage, LMICs","lastPublishedDoi":"10.21203/rs.3.rs-6498074/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6498074/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eElectrical burns represent a significant health burden in low- and middle-income countries (LMICs). In India, approximately 700,000 burn cases annually require hospital admission, with 140,000 fatalities. This study aims to analyze trends, clinical outcomes, and predictors of morbidity and mortality among patients with electrical burns admitted to a specialized burn center in India.\u003c/p\u003e \u003cp\u003e We employed a retrospective cohort study design, reviewing the charts of 220 patients admitted with electrical burns from March 2022 to December 2023. Data collected included demographics, burn characteristics, treatment, and outcomes. Statistical analysis involved descriptive statistics, Wilcoxon Rank-Sum, Fisher\u0026rsquo;s exact test, logistic regression for mortality predictors, and linear regression for length of stay predictors.\u003c/p\u003e \u003cp\u003eThe median age of patients was 20 years, with 85.3% being male and a median weight of 28kg. The median TBSA was 15%, with 87.6% having deep burns. The most common burn regions were the upper limbs (71.7%), lower limbs (66.5%), and hands (55%). High voltage burns constituted 36.3% of cases. Prehospital first aid was administered to 68.1% of patients, and 62.5% underwent surgical intervention, with 23.9% requiring amputations. Complications occurred in 25.1% of cases, including sepsis (14.3%), cardiac arrhythmia (9.6%), and multiple organ dysfunction (8.4%), with an in-hospital mortality rate of 16.7%. TBSA\u0026thinsp;\u0026gt;\u0026thinsp;30% significantly predicted mortality (OR: 2.1, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while mechanical debridement was associated with reduced mortality (OR: 0.73, p\u0026thinsp;=\u0026thinsp;0.016). Prehospital first aid and the presence of deep burns were significant predictors of longer hospital stays.\u003c/p\u003e \u003cp\u003eElectrical burns in India predominantly affect young males and result in severe outcomes. Preventive measures, public awareness, and improved prehospital care are essential to mitigate the impact of electrical burns. Enhanced public safety and targeted interventions are necessary to reduce the burden and improve patient outcomes in LMICs.\u003c/p\u003e","manuscriptTitle":"Electrical Burns Presenting to a Burn Specialty Center in India: Navigating a Public Health and Infrastructure Crisis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-19 07:55:50","doi":"10.21203/rs.3.rs-6498074/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"621cffe5-93c1-4c1a-80eb-0622693387e4","owner":[],"postedDate":"May 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-19T07:55:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-19 07:55:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6498074","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6498074","identity":"rs-6498074","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}