MedStar Health Investigates New Algorithm for Electrical Injury Treatment

Researchers from the Firefighters’ Burn and Surgical Research Laboratory at MedStar Washington Hospital Center examined the utility of an electrical injury treatment algorithm.  This examination compared the incidence of testing done on a cohort of burn patients before and after implementation. Published in the Journal of Burn Care & Research, “Institutional Experience Using a Treatment Algorithm for Electrical Injury” sought to assess the utility of this electrical injury treatment algorithm in identifying patients at risk for complications while reducing unnecessary testing, monitoring, and admissions.

Electrical injury can be associated with high morbidity and mortality but due to its low incidence, evidence-based guidelines to triage and treat electrical injuries are lacking.  Diagnostic tests such as electrocardiogram, serum troponin, and creatine kinase are used in the emergency room to determine the patient’s risk of negative cardiac outcomes. However, the predictive efficacy of these tests is not understood and there is high variability in diagnosis and management among clinicians.

In July 2015, The Burn Center implemented a new algorithm for triage and management of electrical injury. This retrospective cohort study involves patients admitted to The Burn Center over a course of 5 years. The study team hypothesized that protocolized treatment for electrically injured patients will improve quality of care by reducing unnecessary tests, hospital admissions, and ultimately healthcare costs.

Fifty-six patients with electrical injury were admitted to The Burn Center pre-algorithm implementation and 38 patients were admitted post-algorithm implementation. There were no significant differences between groups in terms of age, sex, race/ethnicity, proportion of work-related injuries, or voltage exposure. Furthermore, there were no significant differences between groups in presence or extent of cutaneous burn area, Glasgow coma scale on arrival to the hospital, or proportion of patients with loss of consciousness immediately after sustaining electric shock.

The result show there was no difference in the proportion of patients who received electrocardiogram testing after implementing the algorithm. However, the proportion of patients who received testing in the pre-algorithm cohort was significantly higher for troponin (79% vs 34%), urinary myoglobin (80% vs 45%), and creatine kinase (82% vs 47%). Of 44 patients who had troponin levels tested in the pre-algorithm cohort, only 14% had abnormal results. The results also show there were more days of telemetry monitoring and greater intensive care unit length of stays, prior to algorithm implementation. There were no significant differences in total hospital lengths of stay, incidence of intensive care unit admissions, in-hospital mortality, or 30-day readmissions.

The study team concluded that use of this algorithm allowed for reduction in testing and health care costs without increasing mortality or readmission rates. Further data collection, targeted quality improvement and the use of actual cost-differences vs cost-savings estimates would be considered for future research.

The study team included Saira Nisar, MBBS, MS; John W. Keyloun, MD; Sindhura Kolachana, BS; Melissa M. McLawhorn, RN, BSN; Lauren T. Moffatt, PhD; Taryn E. Travis, MD; Jeffrey W. Shupp, MD; and Laura S. Johnson, MD.

Journal of Burn Care & Research, DOI: 10.1093/jbcr/irab020