Thirty Years of Experience with High-Voltage Injuries: Mechanisms, Current Flow Patterns, and Implications for Cardiac and Renal Failure in Train-Surfing vs. Work-Related Cases

<b>Background:</b> High-voltage injuries pose severe risks, particularly among train surfers and occupational workers. This study compares current flow mechanisms and their association with cardiac failure and kidney function problems in these groups. <b>Methods</b>: A retrospective analysis of 102 patients treated for high-voltage injuries between 1994 and 2024 was conducted, including 32 train-surfing and 70 work-related cases. Demographics, current flow patterns, and complications were analyzed. <b>Results</b>: Train surfers, mostly young males (median age: 19 years), sustained more severe burns compared to older males with work-related injuries (median age: 34 years), with a %TBSA of 47.6% vs. 25.4% (<i>p</i> < 0.0001). Vertical electrical flow was predominant among train surfers (65.62%) and led to cardiac failure in 37.5% of cases. In contrast, diagonal flow was most common in work-related injuries (58.57%). Cardiac failure occurred in 21.57% of all patients, with vertical flow posing the highest risk (38.46%). Kidney failure affected 43.75% of train surfers and 21.43% of work-related cases, with dialysis required in 21.57% overall. Train surfers were more likely to require resuscitation (43.75% vs. 15.71%, <i>p</i> = 0.005), while ECG findings showed no significant differences (<i>p</i> = 0.325). Biomarker levels, such as CK, myoglobin, and troponin, were significantly higher in train surfers, reflecting greater muscle damage. <b>Conclusions</b>: Current flow mechanisms significantly influence cardiac and renal complications. Vertical flow, common in train surfers, is strongly associated with cardiac failure, while work-related injuries exhibit varied flow patterns. These findings highlight the need for targeted prevention strategies and public awareness.