Clinical Patterns and Determinants of Outcomes in Electrical Burn Patients: A Prospective Observational Study from a Tertiary Burn Center in Western India

Abstract Electrical burn injuries represent a severe subset of burn trauma, often complicated by deep tissue necrosis, systemic effects, and limb loss. In India, rapid industrialization, poor infrastructure safety, and limited public awareness contribute to a disproportionately high burden. Although limb amputation has been linked to voltage intensity, burn mechanism, and delayed presentation, prospective data remain scarce. This study aimed to analyze the clinical patterns and determinants of limb loss in electrical burn patients and to identify independent predictors of adverse outcomes. This was a prospective observational study conducted over 24 months (May 2023–April 2025) at a tertiary burn center in Western India, enrolling 110 consecutive patients with electrical burns. Data on demographics, injury characteristics (voltage, burn type, total body surface area [TBSA], cause), clinical course, and outcomes (limb salvage, amputation, mortality) were systematically collected. Statistical analysis employed chi-square tests, t-tests, and binary logistic regression to identify independent predictors of amputation and mortality. This study enrolled 110 patients based on feasibility and patient flow during the study period. No formal prior sample size calculation was performed, which may limit the statistical power of some analyses and is acknowledged as a study limitation. Electrical burns accounted for 7.3% of all burn admissions, with a mean age of 27.6 ± 13.7 years and male predominance (85.5%, p < 0.0001). Seasonal clustering was observed during the monsoon months (48.6%, p < 0.01), with young adults aged 21 to 40 years most affected. High-voltage injuries comprised 67.3% of cases and were significantly associated with amputation (39.2% versus 8.3% in low-voltage, OR 5.2, 95% CI: 2.8–9.6, p < 0.001). Contact burns predominated (50%), followed by flash (26%) and mixed types (24%). Occupational exposures accounted for 44% of cases and formed the dominant pathway to amputation, while agricultural exposures showed the highest amputation rate (53.8%). Overall mortality was 12.7%, confined to high-voltage injuries (18.7% versus 0% in low-voltage, p < 0.01), with TBSA (58 ± 17%) and ICU admissions (71%) strongly associated with fatality. Post-mortem findings revealed lung congestion (71%), renal hemorrhage (57%), and sepsis (36%) as leading causes of death. Limb loss and mortality in electrical burns were governed not by TBSA alone, but by voltage strength, mechanism of burn, and occupational/environmental risk context. The predominance of high-voltage occupational contact injuries underscores infrastructural and workplace vulnerabilities, while agricultural exposures emerged as particularly hazardous. This study highlights that electrical burn outcomes in India are largely preventable yet remain devastating, with high-voltage occupational contact injuries most strongly linked to limb loss and mortality. Preventive strategies focusing on workplace safety, infrastructural improvements, and seasonal awareness campaigns are essential to reduce the burden.