Background
The degree of electrical injury in individual cases can be determined by the path through the body (transthoracic is considered more dangerous due to passage through the heart), type of current (alternating current is more dangerous), amplitude of current, duration of exposure to current, amount of voltage and the area (where current density is inversely proportional to contact area).12-20. Alternatively, minimal injuries may be observed without redness, especially in hidden areas such as under contracted fingers. In many cases of electrocution, especially those of low resistance or low voltage, there may be no injury.
There may be no indication of electrocution at all, the only suggestion is that of a faulty electrical device after evaluation by engineers. 16 While electrical stigmata may be the clearest indication of the cause of death, literature documents that electrical burn marks can be formed postmortem which can confuse matters. Other signs, either macroscopically or by means of additional investigations, can present non-specific12-20 Dilemmas such as coexisting trauma or comorbidities as worthy competitors to electrocution in the formulation of the cause of death.12,-20 Dokov stated that the presence of electrocution stigmata do not necessarily imply that electrocution was the cause of death.5.
Understanding trends associated with power outages can be critical in taking action to reduce or prevent the number of deaths caused by them. Such a foundation can be a useful platform to raise awareness and direct the prevention of such deaths.
Aims and objectives
Analysis of the forensic aspects of electrocution deaths in eThekwini District, Durban, KwaZulu Natal, in terms of anatomical distribution and spectrum of injuries, and additional investigations including blood alcohol concentrations and histology. To determine obstacles that may be encountered in diagnosing deaths due to electrocution in eThekwini Durban, KwaZulu Natal and make suggestions for further research.
LITERATURE REVIEW
Clinical studies described in the review documented higher mortality from high-voltage compared to low-voltage injuries (5.2% and 2.6%, respectively). Barriers encountered include the attribution of electrocution solely as a cause of death in the context of alternative, and equally relevant causes,51 lack of standardization of inclusion criteria for electrocution deaths48 and the over-representation of high-voltage deaths from hospital-based referrals54 which may lead to a false reflection of electrocution statistics.50[Table 1]. Johannesburg Forensic Pathology Service (FPS) is considered one of the busiest medical legal services in the country.
The author agreed with the above study 57 that electrocution was an occasional cause of death in the region served.57,58 The prevalence and trend of electrocution in Kwa Zulu Natal is unknown. In South Africa, age stratification of childhood electrocution shows no electrocution in the under-20s in Johannesburg, "an alarming burden in the under-10s in Cape Town."58 Younger victims in general were also observed in Cape Town. 58. 60 An autopsy study of all childhood and adolescent deaths (0-20 years) from 2005 to 2009 in Pretoria, Gauteng, South Africa found that the highest number of electrocution deaths (73%) occurred in the age group from 1 to 5 years. (8 out of 11 cases) with male predominance.60.
Matthews, in a 2014 inter-provincial pilot study of infant mortality, showed a higher number of electrocutions at the morgue in Phoenix (n=13), in eThekwini, KwaZulu Natal compared to the mortuary at Salt River, Cape Town (n=4). A 2007 NIMSS* report further illustrated that in that year eThekwini electrocutions were highest in the 1 to 4 age group, with no electrocutions in this age group in Johannesburg.62. This could explain the predominance of low-voltage electrocutions in the literature.49 Blumenthal found differences in the prevalence of electrocutions based on the voltage offered to medico-legal institutions.24 In that study, Pretoria accounted for the most electrocution fatalities in generally, including low voltage electrocutions.
However, Blumenthal noted that high-voltage deaths were more likely to occur at night h) or in the early morning hours h).24 The author highlighted the contrast with literature which stated that high-voltage deaths usually occur during the daytime. Sweating was considered an important factor in the lack of external damage seen in the low-voltage electrocutions,43,62 and has been highlighted in the literature.12-20 This factor may not be known or evident at postmortem, and unless a history of sweating or having been sweated . wet is given, this cannot be taken into account. The presentation at autopsy can be appreciated by the injuries primarily in anatomical sites related to active handling of electrical current sources and its path through the body.
Joule burns have been documented mainly in relation to low voltages.12-20,47 and have been observed in up to 93% of cases.43,55,56 The Indian study documented that up to 82% showed only an entry wound.56 Both exit and entrance wounds were documented in the Iranian study and the Croatian study (59.7% and 72% of cases, respectively).56,49. Lindstrom48, how conclusions are made about the impact of individual factors in the cause of death is not voluntarily made. Some authors consider the attribution of a pathway in the mechanism of death in electrocution to be controversial, especially in light of existing comorbidities such as heart disease.42 Blumenthal nevertheless suggested a pathway through the chest in 58% of cases of low voltage with the least established way. postulated as through the head.24 Elevated cardiac enzymes in individuals with lack of coronary artery disease may support a pathway through the heart in electrocutions.12 A pilot study in histological correlation with a history of electrocution showed that cardiac interstitial microbleeding is more common in high-voltage electrocutions, a finding limited by a small cohort.64.
In particular, the vagueness and absence of findings associated with low-voltage electrocutions sometimes supports the use of histology.12-20 Von Caues noted that streaming was the most common histological finding in the 17 cases sampled. Electrocutions are just as likely to occur when alcohol is not used; the interpretation of the mere presence of alcohol in the blood in such a death is also unknown.
DESIGN AND METHODOLOGY
Context
Sites
Sampling strategy
Location of cases
Statistical analysis
Prevalence of electrocution
Age
Sex
Geographic and temporal profile of electrocutions
Post mortem features of electrocution
Mortality databases such as those from the WHO indicate as much as a hundred-fold difference between European countries in the occurrence of electrocution fatalities.38 Morbidity and mortality from electrical injuries vary from. A global review article on adult electrical injury studies between 1946–2015 by Shih et al.42 revealed 41 outcome-based studies; three coronial-based studies, the rest of which are single-institution based. The authors highlighted that data from single institutions may result in an overrepresentation of electrocutions. 49,53,55 Von Caues observed electrocution from 2008 to 2012 at Tygerberg's medico-legal facility in the Eastern Metropole of Cape Town, Western Cape, South Africa.58 A total of 39 deaths were analyzed (0.5% of a total of 8351 unnatural deaths seen).
A descriptive retrospective registry-based study reviewed all autopsied potentially fatal electric shocks at three forensic mortuaries in the eThekwini Metropolitan Municipality of KwaZulu Natal (the second most populous province in South Africa). The province is located in south-eastern South Africa, bordering the Indian Ocean and covers 94,361 km2, making it the third smallest province, out of nine, in South Africa. This is the same growth rate as the Western Cape, even though the Western Cape only has the fourth largest population in the country. All deaths due to electric shock or electrical-related injuries as documented in the cause of death on form B1-1663.
No significant differences were observed in the median age of electrocution cases between years (p=0.5447) or between morgues (p=0.2022). No significant difference was noted in the proportion of injuries to the left and right sides of the body. Electrical fatalities in eThekwini district increased steadily from 2006 to 2013, with a gradual decline from 2013 to 2016.
72 The timeline of electrical supply and the power outages is interesting in the context of this study timeframe. The upward trend in Phoenix for this period is accompanied by the largest change in the number of electrocutions admitted to the Pinetown facility from 2012 to 2013. This may also indicate that electrocutions in the age category 20-39 years occurred before 06h00 .
Electrocutions associated with illicit relationships in eThekwini exceeded those seen in discussed studies, internationally56 and all South African electrocution studies.24,57,58 Typical electrocution victims were men in their third decade of life, with an average age of 25 years. Furthermore, most electrocutions in this study were completed in the absence of histology, either macroscopically with the presence of stigmata or based on history. Similarly, the presence of a peak blood alcohol concentration of 0.55 g/100 ml in this study can cause acute alcohol intoxication by itself and yet present as an electrical death.
67 Compared to other studies in South Africa24,57,58, the postmortem reports provided no evidence to formulate hypotheses about the mode of death of electrocution fatalities in eThekwini. Electrocutions are responsible for significant fatalities in eThekwini and have shown an upward trend over the years of research. In the absence of pathognomonic findings, a critical part of determining or inferring death is based on on-site examination.
There are no autopsy-based studies on fatal electrocutions in the workplace as far as the author is aware.
