PONE-D-22-22946Unconsciousness and amnesia after cross-body electric shocks not involving the headPLOS ONE

Dear Dr. Biering,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Your manuscript has been assessed by two peer-reviewers and their reports are appended below.  The reviewers comment that the article requires more detail on the study design and the methodology. In addition, the reviewers comment that the discussion section should be strengthened by a careful comparison of the presented results with the published literature, and discuss how the current findings could affect future studies and policy making.  Could you please carefully revise the manuscript to address all comments raised?

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Maria Elisabeth Johanna Zalm, Ph.D

Editorial Office

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: No

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors address in a satisfactory way the gap of the examined issue at the introduction section but they should clearly refer the aim of their study at the last paragraph as well as the hypothesis in different sentence .

The methodology design (experimental tests, measurements etc) needs more details. The methodology has important details missing. Subsection for materials and methodology could help the flow.

The results of the study are presented in a satisfactory way

The authors should present the main findings of their study at the first paragraph of the discussion section and also compare their findings to similar studies of the literature. Discussion section is to poor. The authors discuss their findings with no other studies.

Reviewer #2: The manuscript addresses the topic whether immediate CNS symptoms (i.e. unconsciousness, amnesia) might occur in electrical shocks without direct entry or exit point on the head. I appreciate the hypothesis of the study that electric currents flowing through the body and crossing the spinal cord may induce CNS symptoms, even if the head (brain) is not directly affected. This is the first study on this topic. The main strength of the study is the study population because it is based on a prospective cohort of electricians with weekly follow-up.

The data collection and a general description of the shocks are presented in a previous study of the authors including details on the type of electrical shock in terms of current types (AC versus DC) and voltages (low versus high voltage). I recommend to present additionally the numbers for the current types and voltages and to discuss the proportions (e.g., in Table 1) in the present manuscript. Thus, it may be possible to associate the circumstances of the electrical shocks and the outcome further.

Additionally, there are some minor points:

Title: ‘a prospective cohort study’ should be added as an important feature of the study.

The abstract should be structured with the headers ’Introduction’, ‘Material and Methods’, ‘Results’ and ‘Conclusion’.

Line 40: Please provide the risk estimate (i.e. odds ratio (OR).

Line 56: A dot is missing at the end of the sentence.

Line 63: Please add the year in which the study was conducted.

Line 70: Please move the comma to ‘same side’ (non-exposed), ‘opposite side’.

Lines 71-74: These two sentences should be moved to the result section.

Line 83: The risk estimate and confidence interval (95%?) should be provided.

Line 93 and Line 95: Please add the numbers to facilitate reading.

Line 94: A dot is missing at the end of the sentence.

Lines 99: Please delete the dot before the parenthesis.

Lines 101-102 Header of the Table 1: ‘Danish electricians (n=1235)’ is a bit misleading, because 1,235 is the number of events, not of the electricians.

Table1: There is probably a mistake with the numbers in the table because the four columns of gender, age, severity and exposure do not sum up to 1,235, but to 1,264. Please check it. - In column ‘unconsciousness’ and row ‘somewhat severe or worse’ and ‘Not severe or a little severe’ is an error because the sum is not 100%.

Lines 103 and 112: Is the explanation of ‘Combined’ beneath the table correct or should the logical operator only be ‘and’ instead of ‘and/or’?

Line 104-107: Please provide the risk estimates and note the non-significant confidence intervals.

Line 105: Please delete the dot before the parenthesis.

Line 109 Table 2: Please add [CI95%] after OR in the second row and add the abbreviation below the table.

Line 114: Please start the discussion with a sentence on the key results (i.e., number of persons and events).

Line 155: Please use ‘Ann N Y Acad Sci.’ to be consistent.

The manuscript lacks from several punctuation and may benefit from some closer proofreading by a native speaker.

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Reviewer #1: No

Reviewer #2: No

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Unconsciousness and amnesia after cross-body electric shocks not involving the head – a prospective cohort study

PONE-D-22-22946R1

Dear Dr. Biering,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

James Mockridge

Staff Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: No more comments. Thank you for your nice work and the Submission to PlosOne. All issues have been addressed in a satisfactory way.

Reviewer #2: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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