title: Overlooked diagnoses in chronic pain: analysis of survivors of electric shock and lightning strike.
abstract: OBJECTIVE
  Patients who survive lightning strikes are rarely seen in clinical practice and patients with electrical injury are seen infrequently. This article reports the most commonly overlooked diagnoses so that physicians can improve their evaluations.
  
  
  METHODS
  A total of 19 patients who survived a lightning strike and 53 patients who survived electrical shock had a partial or complete multidisciplinary evaluation at Mensana Clinic. A variety of diagnostic studies were ordered.
  
  
  RESULTS
  In 19 lightning strike survivors, referring physicians did not mention 133 diagnoses, later established by Mensana Clinic. The overlooked diagnosis rate was 93%. In 53 patients who survived electrical shock, referring physicians did not mention 436 diagnoses, later established by Mensana Clinic. The overlooked diagnosis rate was 98.2%.
  
  
  CONCLUSIONS
  Patients who survive electric shock and lightning strikes are often misdiagnosed because they are infrequently seen in a medical practice.
authors.affiliation: Mensana Clinic, Stevenson, Department of Neurosurgery, Stevenson, Maryland 21153, USA. Docnelse@aol.com
authors.forename: Nelson
authors.initials: N
authors.lastname: Hendler
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000523:psychology; D003863:Depression / Q000209:etiology; D003937:Diagnosis, Differential; D004556:Electric Injuries / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D015168:Lightning Injuries / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008396:Maryland; D008485:Medical Audit; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects; D010146:Pain / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D018710:Pain Clinics / Q000592:standards* / Q000706:statistics & numerical data; D012017:Referral and Consultation; D012720:Severity of Illness Index; D017741:Survivors; D013997:Time Factors