Early predictors of myoglobiniuria and acute renal failure following electrical injury

Myoglobinuria-induced acute renal failure (ARF) is a potentially lethal con sequence of electrical injury. We describe clinical variables that can pred ict the risk of myoglobinuria and ARF following electrical injury. This was a retrospective multivariate analysis of risk factors among electrically i njured patients over a 26-year period. Urine myoglobin status was documente d in 162 patients; 14% had myoglobinuria. No patient developed ARF, Multiva riate modeling revealed that high-voltage exposure, prehospital cardiac arr est, full-thickness burns, and compartment syndrome were associated with my oglobinuria, Using a prediction rule defined as positive when a patient had greater than or equal to 2 risk factors yielded a sensitivity of 96% and n egative predictive value of 99%. Electrical injury patients with myoglobinu ria have little risk of developing ARF, A prediction rule can be used to sc reen out patients at low risk for myoglobinuria and identify high-risk pati ents who warrant early aggressive treatment and a more definitive myoglobin test. (C) 1999 Elsevier Science Inc.