<p>Electrical injuries often result in severe consequences, posing significant challenges for post-injury treatment. However, there is currently a lack of large-scale and in-depth retrospective studies on the prognosis of electrical injuries. This study was conducted to analyze in depth the clinical prognosis associated with high-voltage and low-voltage electrical injuries. This retrospective study incorporated patients who had suffered from electrical injuries and were admitted to the Burn Department of the First Affiliated Hospital of Army Medical University within the past two decades. Patients were categorized into a high-voltage group (n = 772) and a low-voltage group (n = 654) based on voltage levels. Propensity score matching (PSM) was employed to adjust for baseline characteristic discrepancies between the two groups. Logistic regression analysis, Linear regression analysis, and Kaplan–Meier survival analysis were utilized to evaluate electrical injury outcomes. The primary outcomes encompassed all-cause mortality, 14-day mortality, and amputation incidence. Secondary outcomes included burn severity metrics, comprising burn area, length of hospital stay, and the number of surgeries. Adverse events, including disturbance of consciousness and requirement for tracheotomy, were also evaluated. The study included a total of 1426 patients, with 772 cases of high-voltage electrical injuries and 654 cases of low-voltage electrical injuries. After propensity score matching (PSM), 506 pairs of patients were successfully matched. The analysis demonstrated that, compared to low-voltage injuries, high-voltage electrical injuries were significantly associated with higher amputation rates (OR: 3.02; 95% CI 2.22–4.11; P &lt; 0.001), higher 14-day mortality (HR: 5.40; 95% CI 1.20–24.36; P = 0.01), longer hospital stays (beta: 34.75; 95% CI 24.88–44.62; P &lt; 0.001), larger burn areas (beta: 8.00; 95% CI 6.58–9.43; P &lt; 0.001), and undergoing two or more surgeries (OR: 1.72; 95% CI 1.33–2.23; P &lt; 0.001). Additionally, high-voltage is a significant risk factor for disturbance of consciousness (OR: 2.34; 95% CI 1.78–3.07; P &lt; 0.001) and the requirement for tracheotomy (OR: 11.50; 95% CI 2.71–48.78; P &lt; 0.001). However, no significant correlation was observed between high-voltage injuries and all-cause mortality (P &gt; 0.05). Although high-voltage electrical injuries do not increase all-cause mortality during hospitalization, patients experience higher early mortality (within 14&#xa0;days), more severe symptoms, and poorer prognoses. Therefore, greater emphasis should be placed on the hazards of high-voltage electrical injuries.</p>