Different flames, different fates

BACKGROUND: High-voltage electrical injuries (HVEI) and thermal burns are both classified as severe burn trauma, yet their clinical impact differs markedly. The HVEIs cause deep tissue destruction and systemic complications that are often underestimated in severity by conventional burn indices such as TBSA (Total Body Surface Area) and ABSI (Abbreviated Burn Severity Index). METHODS: A retrospective cohort analysis was performed on 1515 burn patients treated between 1994 and 2024. After exclusions 1489 patients were evaluated, including 92 with HVEI and 1397 with thermal burns. The demographics, burn size, ABSI, intensive care unit (ICU) stay and surgical procedures were analyzed using nonparametric tests. RESULTS: Across the cohort, the mean number of operations was 3.56 (median 3). The HVEI patients required significantly more procedures than thermally injured patients (mean 5.01 vs. 3.49; p < 0.001). Burn size (p < 0.001), ABSI (p < 0.001) and ICU stay (p < 0.001) were all significantly associated with the number of operations. No sex-related differences were observed (p = 0.67). CONCLUSION: The HVEIs impose a disproportionately high surgical and intensive care burden compared to thermal burns. These findings highlight the limitations of current severity scores and emphasize the need for early recognition, repeated surgical management and tailored interdisciplinary care in patients with electrical trauma.