Thirty years of high-voltage injuries: comparative analysis of train surfing and work-related cases with a focus on trauma-associated diagnoses.

Introduction: High-voltage electrical injuries from train surfing pose a unique challenge, often involving severe burns and multisystem trauma. This study retrospectively analyzed train surfing injuries over 30 years, with a focus on trauma-associated diagnoses and comparing them to work-related high-voltage injuries.

Methods: A retrospective review of 87 high-voltage injury cases was conducted, including 30 train surfing and 57 work-related cases. Demographics, injury patterns, injury time, intensive care unit (ICU) stays, surgical interventions, Glasgow Coma Scale (GCS) scores, accident timing and trauma scores (Abbreviated Burn Severity Index (ABSI), Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), National Advisory Committee for Aeronautics Score (NACA), Glasgow Outcome Scale (GOS)) were analyzed.

Results: Train surfers were significantly younger (20.6 years vs. 36.0 years, p < 0.001) and sustained more severe burns (Total Body Surface Area (TBSA): 46.5% vs. 20.8%, p < 0.001). The ABSI (7.1 vs. 5.1, p < 0.01) and ISS (25.0 vs. 12.0, p < 0.001) were higher in train surfers, reflecting greater injury severity. The ICU stays were longer (56.1 days vs. 15.8 days, p < 0.001) and fasciotomies (86.7% vs. 53.0%, p < 0.01) and amputations (56.7% vs. 17.5%, p < 0.001) were more frequent. Train surfers exhibited worse metabolic parameters (base excess -4.49 vs. -0.7 mmol/L, p < 0.001; lactate 3.2 vs. 2.6 mmol/L, p < 0.05) and higher AIS scores for head and thoracic trauma. The GCS at the accident site was lower in train surfers (11.1 vs. 13.0, p = 0.10), indicating more severe initial impairment. Accidents predominantly occurred at night (69.9% of train surfing cases vs. 3.5% of work-related cases, p < 0.001). Mortality was significantly higher in the train surfing group (20.0% vs. 3.2%, p < 0.01).

Conclusion: Train surfing injuries involve extensive burns, severe multisystem trauma, and a higher surgical burden compared to work-related injuries. Their distinct injury patterns necessitate targeted prevention and specialized trauma care.