Strengthening the diagnosis of death due to lightning: an integrated forensic approach - a literature review.

The diagnosis of "death by lightning strike" is typically confirmed through an external postmortem examination. The principle pathological findings are typically located on the external aspects of the body and clothing, while internal examination typically reveals few, if any, specific or diagnostic pathological changes. Following a fatal lightning strike, the victim may have only subtle or no typical findings on the body's surface. Misdiagnoses have occurred repeatedly in the past. Therefore, this literature review investigated whether autopsies of lightning strike victims can lead to or support the correct diagnosis. From a total of 120 case reports on lightning strike accidents with autopsy findings, 34 cases exhibited characteristic injuries that the authors attributed to the lightning strike. The head, heart, lungs, and skeletal system were the most commonly affected areas. Since there is currently no pathognomonic finding for internal injuries after a lightning strike incident, the authors propose at least one additional piece of evidence in addition to a characteristic finding to establish the correct diagnosis. The diagnostic certainty of a lightning-related death may be increased by corroborative evidence, which may include reliable witness accounts, additional trace evidence indicative of a lightning strike at the location where the body was found, or confirmation of lightning activity in the area by a regional lightning detection system.