Abstract

In Reply: My colleagues and I appreciate Dr. Soran's letter and his comments about our article. 1 We welcome the opportunity to address his suggestion that all lightning strike victims be admitted to the hospital. In doing so, we point out that few case series addressing lightning strikes have been published in the medical literature. Our research yielded three case series reports, which involved small numbers of patients accumulated over extended periods of time. Muehlberger et al 2 reviewed 12 patients during a 12-year period. Alar et al 3 discussed 22 patients treated during the course of 23 years. Gluncic et al 4 described 18 patients studied in a 15-year period who sustained ear injuries as a result of lightning strikes. Three other reports described multiple victims of a single lightning strike: 17 victims, 5 10 victims, 6 and 8 victims. 7 As Dr. Soran notes, Aslar et al 3 suggested that all lightning strike victims be admitted to the hospital. Interestingly, of the remaining five case series, only Epperly and Stewart 6 addressed admission criteria. In their article, they recommended that lightning strike victims be admitted to the hospital if they require resuscitation in the field or in the emergency department, if they are comatose, if they have symptoms suggestive of myocardial ischemia, if they develop paralysis, if they demonstrate electrocardiographic changes, if they have neurologic abnormalities, or if they demonstrate autonomic instability. Regarding delayed complications as a result of lightning strikes, Muehlberger et al 2 followed 10 of their 12 patients for an average period of 6.7 years (range, 1 mo–12.3 yr). They found that none of the 10 patients had any delayed or long-term complications. On the basis of their clinical findings and review of the literature, they concluded that the long-term outcome of lightning injuries was more favorable than generally reported. Thus, we remain of the opinion that victims of lightning strike should undergo a detailed history and physical examination with appropriate laboratory studies. Clearly, treatment should be instituted as needed. Patients with noncritical injuries should be observed in the emergency department for several hours. If, after several hours of observation, the patient remains asymptomatic and has normal laboratory studies, the patient may be discharged to home with appropriate follow-up.Jorge A. Martinez, MD, JD