Dataset Information

Acute and long-term clinical, neuropsychological and return-to-work sequelae following electrical injury: a retrospective cohort study.

ABSTRACT:

Objective

To determine acute and long-term clinical, neuropsychological, and return-to-work (RTW) effects of electrical injuries (EIs). This study aims to further contrast sequelae between low-voltage and high-voltage injuries (LVIs and HVIs). We hypothesise that all EIs will result in substantial adverse effects during both phases of management, with HVIs contributing to greater rates of sequelae.

Design

Retrospective cohort study evaluating EI admissions between 1998 and 2015.

Setting

Provincial burn centre and rehabilitation hospital specialising in EI management.

Participants

All EI admissions were reviewed for acute clinical outcomes (n=207). For long-term outcomes, rehabilitation patients, who were referred from the burn centre (n=63) or other burn units across the province (n=65), were screened for inclusion. Six patients were excluded due to pre-existing psychiatric conditions. This cohort (n=122) was assessed for long-term outcomes. Median time to first and last follow-up were 201 (68-766) and 980 (391-1409) days, respectively.

Outcome measures

Acute and long-term clinical, neuropsychological and RTW sequelae.

Results

Acute clinical complications included infections (14%) and amputations (13%). HVIs resulted in greater rates of these complications, including compartment syndrome (16% vs 4%, p=0.007) and rhabdomyolysis (12% vs 0%, p<0.001). Rates of acute neuropsychological sequelae were similar between voltage groups. Long-term outcomes were dominated by insomnia (68%), anxiety (62%), post-traumatic stress disorder (33%) and major depressive disorder (25%). Sleep difficulties (67%) were common following HVIs, while the LVI group most frequently experienced sleep difficulties (70%) and anxiety (70%). Ninety work-related EIs were available for RTW analysis. Sixty-one per cent returned to their preinjury employment and 19% were unable to return to any form of work. RTW rates were similar when compared between voltage groups.

Conclusions

This is the first investigation to determine acute and long-term patient outcomes post-EI as a continuum. Findings highlight substantial rates of neuropsychological and social sequelae, regardless of voltage. Specialised and individualised early interventions, including screening for mental health concerns, are imperative to improvingoutcomes of EI patients.

SUBMITTER: Radulovic N

PROVIDER: S-EPMC6530314 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Acute and long-term clinical, neuropsychological and return-to-work sequelae following electrical injury: a retrospective cohort study.

Radulovic Nada N Mason Stephanie A SA Rehou Sarah S Godleski Matthew M Jeschke Marc G MG

BMJ open 20190514 5

<h4>Objective</h4>To determine acute and long-term clinical, neuropsychological, and return-to-work (RTW) effects of electrical injuries (EIs). This study aims to further contrast sequelae between low-voltage and high-voltage injuries (LVIs and HVIs). We hypothesise that all EIs will result in substantial adverse effects during both phases of management, with HVIs contributing to greater rates of sequelae.<h4>Design</h4>Retrospective cohort study evaluating EI admissions between 1998 and 2015.<h ...[more]

PMID: 31092649

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Project description:ObjectivesFew studies examine the influence of early predictors of work absence beyond 12 months following injury or the time-dependent relative importance of these factors. This study aimed to identify the most important sociodemographic, occupational, health, lifestyle and injury predictors of work absence at 12 and 24?months following injury and to examine changes in the relative importance of these over time.DesignProspective cohort study.SettingThe Prospective Outcomes of Injury Study, New Zealand.Participants2626 injured New Zealand workers aged 18-64 years were identified from the Prospective Outcomes of Injury Study recruited form New Zealand's monopoly injury compensation provider injury claims register: 2092 completed the 12-month interview (80% follow-up) and 2082 completed the 24-month interview (79% follow-up).Primary and secondary outcomes measuresThe primary outcomes of interest was absence from work at the time of the 12-month and 24-month follow-up interviews.ResultsUsing modified Poisson regression to estimate relative risks, important groups of workers were identified at increased risk of work absence at both 12 and 24?months: males, low-income workers, trade/manual workers, temporary employees, those reporting two or more comorbidities and those experiencing a work-related injury. Important factors unique to predicting work absence at 12 months included financial insecurity, fixed-term employment and long weekly hours worked; unique factors at 24 months included job dissatisfaction, long weekly days worked, a prior injury and sustaining an injury that was perceived to be a threat to life.ConclusionsImportant early predictors of work absence at 12 or 24?months following injury are multidimensional and have a time dependent pattern. A consistent set of predictors was, however, present at both time periods that are prime for early intervention. Understanding the multidimensional, time-dependent patterns of early predictors of long-term disability is important to optimally target timely interventions to prevent long-term work disability.

Project description:BackgroundLong-term sickness absence results in increased risks of permanent disability and a compromised quality of life. Return to work is an important factor in reducing these risks. Little is known about return to work factors for long-term sick-listed workers with subjective health complaints. The aim of this study was to evaluate prognostic factors for partial or full return to a paid job for at least 28 days for long-term sick-listed workers with subjective health complaints, and to compare these factors with those of workers with other disorders.MethodsData from a prospective cohort study of 213 participants with subjective health complaints and 1.037 reference participants were used. The participants answered a questionnaire after 84 weeks of sickness absence. Return to work was measured after one and two years. Univariable logistic regression analyses were performed (P ≤ 0.157) for variables per domain with return to work (i.e. demographic, socio-economic and work-related, health-related, and self-perceived ability). Subsequently, multivariable logistic regression analyses with backward selection (P ≤ 0.157) were performed. Remaining factors were combined in a multivariable and final model (P ≤ 0.05).ResultsBoth for workers with subjective health complaints and for the reference group, non-health-related factors remained statistically significant in the final model. This included receiving a partial or complete work disability benefit (partial: OR 0.62, 95% CI 0.26-1.47 and OR 0.69, 95% CI 0.43-1.12; complete: OR 0.24, 95% CI 0.10-0.58 and OR 0.12, 95% CI 0.07-0.20) and having a positive self-perceived possibility for return to work (OR 1.06, 95% CI 1.01-1.11 and OR 1.08, 95% CI 1.05-1.11).ConclusionsNon-health-related factors seem to be more important than health-related factors in predicting return to work after long-term sickness absence. Receiving a work disability benefit and having negative expectations for return to work seem to complicate return to work most for workers with subjective health complaints. With respect to return to work predictors, workers with subjective health complaints do not differ from the reference group.

Dataset Information

Acute and long-term clinical, neuropsychological and return-to-work sequelae following electrical injury: a retrospective cohort study.

Objective

Design

Setting

Participants

Outcome measures

Results

Conclusions

Publications

Acute and long-term clinical, neuropsychological and return-to-work sequelae following electrical injury: a retrospective cohort study.

Similar Datasets

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