One hundred ninety-five cases of high-voltage electric injury

High-voltage electric injury (HVEI) is associated with a high incidence of extremity compartment syndrome and of major amputation. The purpose of this study was to review our experience with HVEI and to attempt to develop predictors of the need for fasciotomy and amputation in patients with HVEI. The records of the 195 patients with HVEI who were admitted to a single burn center during a 19-year period were reviewed. Evidence for muscle necrosis, to include myoglobinuria and elevated creatine phosphokinase (CPK) levels, was noted. A total 187 patients (95.9%) survived to hospital discharge. A total of 56 underwent fasciotomy within 24 h of injury; 80 patients underwent an amputation during the hospitalization. Fasciotomy was predicted by presence of myoglobinuria with an overall accuracy of 72.8%. Amputation was predicted by a logistic model incorporating myoglobinuria, undergoing a previous fasciotomy, and age, with an overall accuracy of 73.3%. HVEI was associated with high amputation risk and a low rate of mortality in patients admitted to our burn center. Patients with gross myoglobinuria are at higher risk of requiring fasciotomy and/or amputation.