Cardiac monitoring not needed in household electrical injury if the patient is asymptomatic and has a normal ECG
Date First Published:
March 1, 2000
Last Updated:
November 8, 2003
Report by:
Wendy Dollery, Consultant in Emergency Medicine (Manchester Royal Infirmary)
Search checked by:
Katrina Herren, Manchester Royal Infirmary
Three-Part Question:
In [patients who have sustained a household voltage electrical injury with normal initial ECG] is [admission for monitoring] necessary to [reduce the risk of sudden death from cardiac arrhythmias]?
Clinical Scenario:
A 30 year old male elctrician attends the emergency department having suffered an electrical shock while servicing a washing machine. There was no water involved.
Search Strategy:
Medline 1966-10/03 using the OVID interface.
Search Details:
[exp electric injuries OR exp burns, electric OR electric injuries.mp OR electrocution.mp] AND [exp monitoring, physiologic OR monitoring.mp]
Outcome:
102 papers found of which 96 were irrelevant. The remaining 6 papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Household electrical shocks: who should be monitored? Fatovich DM, Lee KY. 1991, Australia | 20 patients exposed to 240 volts AC electric supply | Observational study, literature review | Initial ECG, cardiac monitor | 2/20 abnormal, no new abnormality detected | Retrospective, no statistical analysis |
| The need for cardiac monitoring after electrical injury. Cunningham PA. 1991, Australia | 70 patients exposed to 240 AC electric supply | Observational study, survey of management policy | Initial ECG, cardiac monitor | 11/59 abnormal, 6 deaths, no new abnormality detected | Retrospective analysis, no statistical analysis |
| Cardiac monitoring of children with household electrical injuries. Bailey B, Gaudreault P, Thiverge RL, et al. 1995, Canada | 151 children (8 months to 18 years) exposed to 120 or 240 volts AC electric supply | Observational study | Initial ECG, cardiac monitor | 1/113 abnormal, no new abnormality detected | Retrospective, missing data |
| Electrical injuries in a pediatric emergency department. Garcia CT, Smith GA, Cohen DM, et al. 1995, USA | Patients aged less than 21 years exposed to minor (<1000 volts) electrical injury | Observational study | Initial ECG, cardiac monitor | 2/53 abnormal, no new abnormality detected | Retrospective, missing data |
| Retrospective evaluation of admission criteria for paediatric electrical injuries. Wallace BH, Cone JB, Vanderpool RD, et al. 1995, USA | 26 children exposed to 120 or 240 volts AC electric supply | Observational study | Initial ECG, cardiac monitor | 1/17 abnormal, no new abnormaility detected | Retrospective |
| A three year prospective audit of 212 presentations to the emergency department after electrical injury with a management protocol. Blackwell N, Hayllar J. 2002 Australia | 202 patients presenting to an Emergency Department in Australia. Patients were seen and underwent a 6 hour protocol to rule out any significant injury. A large number of patients came from a single industrial source. 186 patients with 196 injuries were included (some turned out not to be electrocuted ). |
Prospective cohort study | No of patients with normal ECG who went to have adverse event | No episodes | 3% of patients did not complete 6 hours of monitoring. Many patients attended as a result of company policy at a nearby facility. This may be a different group from other EDs. |
| Number of patients with abnormal ECG opn arrival | 8/196 had ECG abnormalities on arrival | ||||
| Do children need to be monitored after electric shocks? Wilson CM, Fatovitch DM. 1998 Australia | 40 children presenting to an emergency department following electrical injury. | Observational | Number with abnormal ECG on arrival | Jan-40 | Children only |
| Number who subsequently developed ECG abnormality | none |
Author Commentary:
While there are numerous case reports in the literature of dysrythmias developing after both 240 and high voltage electrical injury no studies have shown onset of dysrythmias after initial assessment. Only observational studies were identified looking at household electrical injury and late onset cardiac arrythmias.
Bottom Line:
Routine cardiac monitoring is not required after household voltage electrical injury if the patient is asymptomatic and has nomral initial electrocardiography. Asymptomatic patients involved in minor electrical events do not require investigation or admission.
Level of Evidence:
Level 2: Studies considered were neither 1 or 3
References:
- Fatovich DM, Lee KY.. Household electrical shocks: who should be monitored?
- Cunningham PA.. The need for cardiac monitoring after electrical injury.
- Bailey B, Gaudreault P, Thiverge RL, et al.. Cardiac monitoring of children with household electrical injuries.
- Garcia CT, Smith GA, Cohen DM, et al.. Electrical injuries in a pediatric emergency department.
- Wallace BH, Cone JB, Vanderpool RD, et al.. Retrospective evaluation of admission criteria for paediatric electrical injuries.
- Blackwell N, Hayllar J.. A three year prospective audit of 212 presentations to the emergency department after electrical injury with a management protocol.
- Wilson CM, Fatovitch DM.. Do children need to be monitored after electric shocks?