Introduction

It is estimated that 4% of all United States hospital burn unit admissions are for electrical trauma. High-voltage electric shock can produce devastating damage that often leaves the survivor with permanent injuries. More than 90% of these injuries occur in males between the ages of 20 and 34 and are work related. Mortality rates from electrical trauma range from 3% to 15%, more than 1000 deaths per year in this country alone.

These injuries are generally quite complex. Extensive skeletal muscle, neural and vascular tissue injury is characteristically scattered in its distribution along the current path. Major limb amputation rates have been reported to be as high as 71%. These statistics represent several thousand injured young adults each year. An incomplete understanding of the pathophysiology of tissue injury and an inability to accurately diagnose the extent of electrical injury at the time of admission seriously impede effective clinical management. Furthermore, the variable circumstances of accidental electrical shock make it nearly impossible to formulate valid empirical guidelines for predicting the extent of tissue damage.

Over the past two decades, the clinical outcome for the electrical trauma victim has not improved substantially. To some extent, this has resulted from the slow progress in understanding the underlying pathophysiology of tissue injury. Unfortunately, fundamental misconceptions about the nature of electrical trauma, arising from the complex interdisciplinary nature of the underlying pathophysiology of electrical injury, have obscured the basic issues and have complicated the problem.