Purpose: Acute management of electrical injury has been guided historically by magnitude of voltage. However, long-term outcomes have not been fully examined and may not correlate with severity of mechanism. This review compares high (>1000 volts) and low voltage injuries, focusing on functional recovery.

Methods: Patients with electrical injuries admitted to an accredited burn center were compared via t-test and chi-square, with significance assigned to p values <0.05.

Results: From 2000-2005, we managed 115 patients with high voltage (n=60), low voltage (n=25), flash arc (n=29), and lightning (n=1) injuries (mean follow-up: 352 days). High voltage patients, compared to low voltage, had a larger TBSA (9.9% vs 1.8%); longer ICU stay (8.5 days vs 0.6 days) and hospitalization (17.7 vs 4.4 days); and higher rates of fasciotomy (28.3% vs 4%), amputation (23.3% vs 0%), nerve decompression (37% vs 12%), and outpatient reconstruction (51.7% vs 24%) (p<0.05), with 4 cases of renal failure and 2 deaths. Despite these differences, high and low voltage groups experienced similar rates of neuropsychiatric sequellae (48% vs 44%), limited return to work (37% vs 28%), and delays in return (166 days vs 216 days). Final impairment ratings for the high and low voltage groups were 17.5% and 5.3%, respectively.

Conclusions: Electrical injuries can produce significant morbidity despite relatively small burn size. Neuropsychiatric sequellae, combined with limited return to work, dispel the myth that low voltage electrical burns are minor injuries. These challenges highlight the need for an integrated plan that includes early reconstruction to facilitate rehabilitation.