Clinical Characteristics and Predictors of Adverse Outcomes in Electrical Injuries: A Five-Year Retrospective Study in the Emergency Department

Introduction: Electrical injuries represent a critical medical emergency, presenting with diverse clinical manifestations from localized tissue damage to systemic complications, contributing significantly to global morbidity and mortality. Injury severity is determined by factors such as the current type (AC/DC), voltage, contact duration, tissue resistance, and the current pathway. Despite existing literature on factors influencing clinical outcomes, evidence predicting adverse events based on initial emergency department (ED) presentation remains limited. This study aims to identify clinical and biochemical markers at ED admission that will help predict poor clinical outcomes (e.g., intensive care unit (ICU) admission, prolonged hospitalization, or complication development) in electrical injury patients. Material and Methods: This retrospective observational study analyzed electrical injury patients (ICD-10 codes T75.4, W86, and W87) at Van Erciş Şehit Rıdvan Çevik State Hospital ED from January 2020 to January 2025. Data encompassing demographics, event details, clinical findings (e.g., mental status, burns, ECG, chest X-ray), and outcomes were retrospectively collected. Ethical approval was granted, with informed consent waived due to the retrospective design. Statistical analyses included chi-square, independent samples t-test, Mann-Whitney U, Kruskal-Wallis, Spearman correlation, linear and logistic regression, and ROC curve analysis; p < 0.05 was considered significant. Results: Of the 142 patients included in the study, 65.5% were male, with peak incidences in the 21 years and older (35.9%) and 5 years and younger (28.9%) age groups. Most injuries occurred domestically (85.9%) from electrical appliances (54.9%), involving alternating current (95.8%). Non-normal sinus rhythm (non-NSR) on ECG correlated strongly with ICU admission, with all 13 non-NSR patients admitted to ICU. Other predictors of adverse outcomes included outdoor injury location, direct current (DC) exposure, foot/head contact, fall from height (71.4% of patients requiring ICU admission), altered mental status (91.7% of unconscious patients requiring ICU admission), and severe burns. ROC analysis demonstrated high predictive value for CK (> 174.00 U/L; sensitivity 92.3%, specificity 77.6%), CK-MB (> 27.50 U/L; sensitivity 92.3%, specificity 80.2%), and lactate (> 1.75 mmol/L; sensitivity 76.9%, specificity 72.4%). Linear regression identified lactate and hemoglobin as significant predictors of prolonged hospital stay. Multivariate logistic regression revealed positive chest X-ray findings (OR: 15.013, p < 0.001) and elevated lactate levels (OR: 5.698, p < 0.001) as independent predictors of poor clinical outcome; electrical appliance as the source was protective (OR: 0.210, p = 0.043). Conclusions: Early ED evaluation of ECG findings and laboratory parameters (lactate, hemoglobin, CK, CK-MB) demonstrates significant prognostic value in electrical injury patients. Clinical data, including the nature of the event, contact area, and burn severity, are also critical for guiding treatment. A multidisciplinary approach and prompt risk stratification in the ED are essential to reducing morbidity and mortality in these cases.