Abstract

To the Editor: Whitcomb et al 1 discussed lightning injuries in a recent case report and review in the Southern Medical Journal. My colleagues and I published an article on the same topic in the International Journal of Clinical Practice in 2001. 2 In our comprehensive review article, we presented 22 hospitalized cases treated during a 23-year period. The incidence was 3 per 1,000 burns, which ranked lightning as the fourth-leading cause of burns after electrical injury. The mean age of the victims was 32.9 years (age range, 12–65 yr), with male predominance (60%). Fortunately, there were no deaths in our study, and the mean duration of hospitalization was short (17.3 d; range, 1–62 d) compared with other causes of burns (mean duration of hospitalization 31.3 d in electrical injuries, 27.2 d in flame injuries, and 24.1 d in chemical injuries). The burned body surface ranged from 5 to 20% (average, 14%), and our approach after stabilizing the patient was early debridement, which was performed in 69% of patients. As Whitcomb et al 1 mentioned in their article, the commonest early stage complaints were confusion (73%), temporary amnesia (23%), and cystitis (19%). During long-term follow-up, the most common morbidity was chronic pain syndrome, but patients had anxiety, sleep disorder, fear of storms, and amnesia as well. When I first read the Whitcomb et al 1 article, my expectation was to see our relatively high number of lightning patients cited in this literature. My other expectation was to find their institutional experience with the overall incidence rate in addition to the case presentation. I disagree with Whitcomb et al's 1 conclusion that lightning injuries may be managed on an outpatient basis, even if the patient has no initial complications of the lightning strike, has normal findings on physical and laboratory examinations, and remains asymptomatic. We have an institutional policy in Turkey that all lightning injuries should be hospitalized for at least 1 day, regardless of the victim's appearance, and the patient may be discharged after comprehensive medical examinations, diagnostic tests, and multidisciplinary consultations are performed. This may be adding more cost to the bill, but we think that on behalf of the victim, to stay on the safe side, it is more important than a couple hundred dollars. Any undiagnosed early or late morbidity will add more psychological and physical cost to the patient.Atilla Soran, MD