Peripheral Nerve Injury in the Electrical Burn Patient: A Systematic Review and Meta-Analysis
Elizabeth Blears, MD, MMS1, Jessica Ballou, MD, MPH1, Aidan Weitzner, BS2, Julie Caffrey, DO, MS1 and A. Lee Dellon, MD, PhD3, 1Johns Hopkins University, Baltimore, MD, 2Johns Hopkins University School of Medicine, Baltimore, MD, 3The Dellon Institute, Towson, MD
Introduction: Electric burn injuries result in peripheral nerve injuries more than in other mechanisms of burns because peripheral nerve tissue has the least resistance and preferentially conducts electricity. This physiology predisposes injury to the nerves, either in the acute or long-term phase. While fasciotomy and nerve decompression are often performed routinely, this analysis synthesizes the available patient data within the literature to determine whether or not they are effective in preventing symptoms of peripheral nerve dysfunction such as weakness, pain or paresthesia.
Methods: A literature review of human subjects having experienced electric burns was performed according to PRISMA Guidelines to characterize. Data were extracted to summarize known incidence, demographic characteristics and patterns of peripheral nerve injury. Meta-analysis was performed from available nerve conduction studies and electromyography were pooled to assess objective measurements of electric nerve injuries. Fasciotomy was defined as release of muscular compartments of extremities. Nerve decompression procedures included carpal tunnel release, cubital tunnel release as well as other decompressions for named nerves. Patients were characterized as having undergone nerve decompression in the acute phase (within 30 days of injury) or long-term phase (30 days or thereafter).
Results: The 119 articles for systematic review included 16,773 patients, although these studies were heterogenous and at high risk of bias. Motor symptoms (weakness or paralysis) were the most common type of peripheral nerve symptom described and were reported in 9% of patients. Patients who underwent fasciotomy acutely had significantly lower rates of weakness when measured at the date of the last follow-up as compared to those who did not undergo fasciotomy (42.1% vs. 79.7%, P< 0.001) as well as lower rates of sensory dysfunction (23.3% vs. 86.9%, P<0.0001). Nerve decompression, at any point in time, did not yield statistically significant differences in rates of nerve symptoms (P=0.124); however, of the 3 studies that reported performance of decompression in the long-term phase, patients reported improvement of symptoms.
Conclusions: While there is a wide variety of literature on electrical burn injuries, a paucity of high-quality evidence exists about the clinical manifestations, diagnostic standards, and best treatment options for injuries to peripheral nerves. Fasciotomies are associated with improved outcomes. However, localized nerve decompression is likely to provide benefit if peripheral nerve symptoms persist after one-year post-injury, but further research is needed to define its role in management.
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