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Emergency Department Visits for Heat Stroke in the United States, 2009 and 2010
Abstract and Figures
Background
The effect of extreme heat on health has become a growing public health concern due to climate change. We aimed to examine the epidemiological patterns of hospital-based emergency department (ED) visits for heat stroke in the United States.
Findings
We analyzed data from the 2009 and 2010 Nationwide Emergency Department Sample, the largest ED data system sponsored by the Agency for Healthcare Research and Quality. ED visits for heat stroke were identified by screening the recorded diagnoses using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 992.0. Annual incidence rates of ED visits for heat stroke were computed according to demographic characteristics and geographic regions. In 2009 and 2010, there were an estimated 8,251 ED visits for heat stroke in the United States, yielding an annual incidence rate of 1.34 visits per 100,000 population (95% Confidence Interval [CI] = 1.23-1.45). Significantly higher incidence rates were found in males (1.99 per 100,000; 95% CI = 1.82-2.16), adults aged ≥ 80 years (4.45 per 100,000; 95% CI = 3.73-5.18), and residents living in the southern region (1.61 per 100,000; 95% CI = 1.43-1.79). The majority (63.1%) of ED visits for heat stroke occurred during the summer months of June, July and August. Over one-half (54.6%) of the ED visits for heat stroke required hospitalization and 3.5% of the patients died in the ED or hospital.
Conclusions
Heat stroke results in approximately 4,100 ED visits each year in the United States, with the majority occurring in the summer months and requiring admission to the hospital. Men, the elderly, and people living in the south region are at heightened risk.
Electronic supplementary material
The online version of this article (doi:10.1186/2197-1714-1-8) contains supplementary material, which is available to authorized users.
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... On the health and wellbeing side, it is estimated that, annually, thousands of people die in Europe because of exposure to extreme heat. During 2003 alone, heat stoke caused approximately 30,000-70,000 fatalities in Europe [9], with vulnerable people such as low-income, minority, and elderly populations being disproportionally affected [5,10]. Many of these deaths may have been prevented if people could cool their homes properly and if they could afford air conditioning. ...
Energy poverty has impressive negative effects on people’s health. Alleviating energy poverty is crucial for a just and equitable transition. However, policies and attempts to reduce energy poverty present a challenge to researchers and policymakers due to its complexity. The lack of a clear definition, of a common set of metrics to assess its multiple dimensions, and of spatially explicit assessments represent serious shortcomings that hinder effective policy design. This paper aims to explore the relevance and spatial distribution of the determinants of vulnerability to energy poverty to support the design of effective responses at different scales. To this end, a principal component (PCA) and a geographically weighted principal component analysis (GWPCA) are conducted on more than 1300 municipalities in 15 Italian metropolitan areas, to identify the spatial patterns of vulnerability to energy poverty and its causes. The PCA highlights three main components of vulnerability to energy poverty in the study areas, respectively, related to the job condition and to individual and households’ socioeconomic factors, which provide relevant insights for policies at the national level, The GWPCA provides more detailed information to effectively support policies at the local level. The novelty of this work is the comparison of results from a PCA and a GWPCA of their different contributions to policy design at different scales.
... Incidence is difficult to estimate globally due to lack of an accepted system for capture and reporting. In the US, for example, one study estimated over 4,100 emergency department visits per year for heat stroke, an annual national incidence rate of 1.34 visits/100,000 people; this analysis noted a case fatality rate of 3.4% (54). A 2015 report by the WHO notes that heat waves are an emerging public health problem as climate change worsens (55), which further suggests that conditions such as heat stroke and its sequelae may become more common in the future. ...
Background
The World Health Organization (WHO)’s Essential Medicines List (EML) plays an important role in advocating for access to key treatments for conditions affecting people in all geographic settings. We applied our established drug repurposing methods to one EML agent, N-acetylcysteine (NAC), to identify additional uses of relevance to the global health community beyond its existing EML indication (acetaminophen toxicity).
Methods
We undertook a phenome-wide association study (PheWAS) of a variant in the glutathione synthetase (GSS) gene in approximately 35,000 patients to explore novel indications for use of NAC, which targets glutathione. We then evaluated the evidence regarding biologic plausibility, efficacy, and safety of NAC use in the new phenotype candidates.
Results
PheWAS of GSS variant R418Q revealed increased risk of several phenotypes related to non-acetaminophen induced acute liver failure (ALF), indicating that NAC may represent a therapeutic option for treating this condition. Evidence review identified practice guidelines, systematic reviews, clinical trials, retrospective cohorts and case series, and case reports. This evidence suggesting benefit of NAC use in this subset of ALF patients. The safety profile of NAC in this literature was also concordant with existing evidence on safety of this agent in acetaminophen-induced ALF.
Conclusions
This body of literature indicates efficacy and safety of NAC in non-acetaminophen induced ALF. Given the presence of NAC on the EML, this medication is likely to be available across a range of resource settings; promulgating its use in this novel subset of ALF can provide healthcare professionals and patients with a valuable and safe complement to supportive care for this disease.
... This data indicates that heat stroke leads to around 4,100 ED visits annually in the U.S., with specific groups being more susceptible. [21] Heat Stroke in Saudi Arabia & Pilgrimage: ...
Background: Heat stroke is a severe health concern with the potential for multi-organ failure, necessitating rapid and effective management. With rising global temperatures, there is increasing concern regarding the vulnerability of populations in high-heat areas, notably in Saudi Arabia, especially during the annual Hajj pilgrimage. Objective: This paper aims to review the epidemiology, evaluation and management techniques of heat stroke, emphasizing the situation during Hajj pilgrimages in Saudi Arabia, and to outline the best practices for emergency management. Methodology: A comprehensive review of literature and studies related to heat stroke, both globally and specific to Saudi Arabia, was undertaken. An in-depth analysis of emergency management, including initial assessment, cooling methods, organ support, medication, and prevention strategies, was conducted. Results: Heat stroke remains a significant cause of emergency department visits, with specific groups, such as men and the elderly, being more susceptible. During the Hajj in 2016, 267 patients were diagnosed with heat-related illnesses, with heatstroke accounting for 29% of these cases. With the threat of global warming, studies indicate a potential tenfold increase in heat stroke risk with a 2°C rise in temperatures. Swift and comprehensive cooling is pivotal for recovery. Management emphasizes rapid recognition, assessment, and varied cooling methods, along with targeted treatments for organ dysfunctions. Prevention strategies play a vital role, given the higher efficacy and practicality over treating organ dysfunctions. Conclusion: Heat stroke is a pressing health challenge, particularly in high-risk environments like Saudi Arabia during the Hajj pilgrimage. While effective emergency management protocols exist, an emphasis on prevention is crucial. It is imperative to incorporate a comprehensive approach to address both the immediate threat and long-term risks of heat stroke, especially with the looming challenge of global warming.
... The impact of an extremely hot environment on health has become a growing concern and a burden on public health [6]. According to the data provided by the largest emergency department (ED) data system from 2009 to 2010 in the USA, the number of emergency visits because of heatstroke was estimated to be 8251, 54.6% of whom needed hospitalization, and 3.5% of whom died in EDs or hospitals [7]. In a recent study, 1152 cases of severe heatstroke with 10% mortality were reported from 2013 to 2017 in Shanghai, China [8]. ...
Background
Coma has been considered as a valuable symptom of heatstroke. This study aimed to evaluate the role of the Glasgow Coma Scale (GCS) as an indicator of prognosis of patients with heatstroke.
Material/Methods
From Jan 1st, 2013 to Dec 31st, 2020, the clinical courses of 257 heatstroke patients from 3 medical centers in Guangdong, China, were observed. Diagnosis of heatstroke was made according to Expert Consensus in China. GCSs were calculated on the 1st, 3rd, and 5th days after admission to intensive care units (ICUs). GCS ≤8, as a coma criterion, was employed to predict the outcomes.
Results
Seventy-five patients (29.18%) were comatose at admission. Twenty-seven (10.50%) patients, including 24 (24/75, 32.00%) coma patients and 3 (3/182,1.65%) non-coma patients died during ICU stay (P<0.0001). Patients with GCS ≤8 had a 2-fold higher risk of death as compared with those with GCS >8. The area under curves (AUCs) of GCSs on the 1st, 3rd, and 5th days to predict mortality were 0.81 (0.70–0.91), 0.91 (0.84–0.98), and 0.91 (0.82–0.99), respectively. Each additional 1 year of age, 1/min of respiratory rate (RR), and 1% of hematocrit (HCT) increased the risk of death of coma patients by 3%, 6%, and 4%, respectively (all P≤0.05). Patients with improving GCSs had lower mortality rates than non-improving patients (5.71% vs 55.00%, P<0.0001) within 5 days after admission.
Conclusions
GCS ≤8 at admission predicted worse outcomes in heatstroke patients, which possibly enhanced the risks of death for other factors, including age, RR, and HCT.
... It is estimated that, annually, 1300 people die every year in the U.S. from extreme heat 3 . In 2009 and 2010 alone, over 8250 emergency room visits in the US were caused by heat stroke 4 , with lowincome, minority, and elderly populations being disproportionally affected 3 . A large portion of these deaths may have been prevented if people could cool their homes properly. ...
Income-based energy poverty metrics ignore people’s behavior patterns, particularly reducing energy consumption to limit financial stress. We investigate energy-limiting behavior in low-income households using a residential electricity consumption dataset. We first determine the outdoor temperature at which households start using cooling systems, the inflection temperature. Our relative energy poverty metric, the energy equity gap, is defined as the difference in the inflection temperatures between low and high-income groups. In our study region, we estimate the energy equity gap to be between 4.7–7.5 °F (2.6–4.2 °C). Within a sample of 4577 households, we found 86 energy-poor and 214 energy-insecure households. In contrast, the income-based energy poverty metric, energy burden (10% threshold), identified 141 households as energy-insecure. Only three households overlap between our energy equity gap and the income-based measure. Thus, the energy equity gap reveals a hidden but complementary aspect of energy poverty and insecurity. In the summer, low-income households in the Arizona, US wait 4 - 7 °F (2.6–4.2 °C) longer than high-income households to turn on their AC units to save money on energy bills. This energy limiting behavior indicates a hidden form of energy poverty.
... It is estimated that, annually, 1,300 people die every year in the U.S. from extreme heat 3 . In 2009 and 2010 alone, over 8,250 emergency room visits in the US were caused by heat stroke 4 , with low-income, minority, and elderly populations being disproportionally affected 3 . A large portion of these deaths could have been prevented if people could cool their homes properly 5,6 . ...
Income-based energy poverty metrics miss people's behavior (i.e., reducing energy consumption to limit financial stress). We introduce a novel method for calculating energy-limiting behavior in low-income households using a residential electricity consumption dataset. We first determine the outdoor temperature at which households start using cooling systems, the inflection temperature. Our energy poverty metric, the energy equity gap , is defined as the difference in the inflection temperatures between low and high-income groups. In our study region, we estimate the energy equity gap to be between 4.7°F and 7.5°F. In 2015–2016, within our sample of 4,577 households, we found 86 energy-poor and 214 energy-insecure households. In contrast, the income-based energy burden metric identified 141 households as energy insecure when the threshold was set to 10%. Only three households overlapped between the energy equity gap and energy burden measures. Thus, the energy equity gap reveals a hidden but complementary aspect of energy poverty.
... Our study reported an in-hospital mortality rate of 5%, which has been previously reported ranging from 3% to 7%. 16,20,21,30,33 When considering mortality as a result of heatstroke, environmental heatwaves are an important external factor to consider. Previous data showed a concerning rise in deaths during heat wave in Europe in August 2003 and Chicago in the summer of 1995. ...
Background
This study aimed to assess inpatient prevalence, characteristics, outcomes, and resource utilisation of hospitalisation for heatstroke in the United States. Additionally, this study aimed to explore factors associated with in‐hospital mortalities of heatstroke.
Methods
The 2003‐2014 National Inpatient Sample database was used to identify hospitalised patients with a principal diagnosis of heatstroke. The inpatient prevalence, clinical characteristics, in‐hospital treatments, outcomes, length of hospital stay, and hospitalisation cost were studied. Multivariable logistic regression was performed to identify independent factors associated with in‐hospital mortality.
Results
A total of 3372 patients were primarily admitted for heatstroke, accounting for an overall inpatient prevalence of heatstroke amongst hospitalised patients of 36.3 cases per 1 000 000 admissions in the United States with an increasing trend during the study period (P < .001). Age 40‐59 was the most prevalent age group. During the hospital stay, 20% required mechanical ventilation, and 2% received renal replacement therapy. Rhabdomyolysis was the most common complication. Renal failure was the most common end‐organ failure, followed by neurological, respiratory, metabolic, hematologic, circulatory, and liver systems. The in‐hospital mortality rate of heatstroke hospitalisation was 5% with a decreasing trend during the study period (P < .001). The presence of end‐organ failure was associated with increased in‐hospital mortality, whereas more recent years of hospitalisation was associated with decreased in‐hospital mortality. The median length of hospital stay was 2 days. The median hospitalisation cost was $17 372.
Conclusion
The inpatient prevalence of heatstroke in the United States increased, while the in‐hospital mortality of heatstroke decreased.
This study investigates the molecular responses to heat stroke in young and old patients by comparing whole-genome transcriptomes between age groups. We analyzed transcriptomic profiles from patients categorized into two age-defined cohorts: young (mean age = 44.9 ± 6 years) and old (mean age = 66.1 ± 4 years). Control subjects, exposed to similar environmental heat conditions but without developing heat stroke, were also included in the analysis to provide a baseline for comparison. Despite uniform heat stroke severity at admission, as indicated by core body temperature, consciousness level, and organ damage markers, notable gene expression differences emerged. Old patients showed 37% fewer differentially expressed genes compared to young patients at admission, with a shift towards gene upregulation, deviating from the usual downregulation seen in heat stress responses. Both age groups exhibited increased heat shock protein gene expression, activated the heat stress and unfolded protein responses indicating comparable proteotoxic stress. Nonetheless, age-specific differences were evident in critical regulatory pathways like Sirtuin, mTOR, and p53 signaling, along with key pathways related to proteostasis, energy metabolism, oxidative stress, and immune responses. Following cooling, older adults exhibited a decline in the heat stress response and a cessation of the unfolded protein response, in contrast to the sustained responses seen in younger individuals. This pattern suggests an age-related adaptability or a diminished protective response capacity with aging. These findings provide insights into the biological mechanisms that may contribute to age-specific vulnerabilities to heat.
To prepare the population for first aid in case of heat and sunstroke in the context of global warming, algorithms for the basics of didactics of the educational topic “Heat and sunstroke” of the subject “Life safety” are proposed. The 30-year experience of teaching the subject in humanitarian state educational institutions of higher professional education of a non-medical profile in Syktyvkar is summarized. For each of the considered educational issues, a brief summary of the material presented is given.
Heat stress disorders or heat-related illnesses are a kind of physiological damage that occurs when the body cannot dissipate enough heat due to its thermoregulatory dysfunction. This paper aims to summarize the latest information on the diagnosis and treatment of heat-related illnesses. Heat stress disorders come in a variety of forms including heat edema, heat rash, heat cramps, heat syncope, heat tetany, severe heat exhaustion, and life-threatening heatstroke. Major risk factors may include excessive exercise, continuous exposure to high temperatures or humid environments, lack of acclimation, excessive clothing or protective equipment, obesity, and dehydration. Additional risk factors may include the patientʼs existing medical condition, environmental and personal factors, and the use of various drugs. Mild heat-related illnesses can be treated only by supportive care such as moving patients to a cool place and laying them in a supine position while elevating their legs and loosening their clothes. However, in the case of heatstroke, quickly lowering the body temperature is an essential in reducing the mortality rate. The most effective cooling method is to immerse the entire body in ice cold water.
This study was conducted to investigate the relationship between heat-related illnesses developed in the summer of 2012 and temperature.
The study analyzed data generated by a heat wave surveillance system operated by the Korea Centers for Disease Control and Prevention during the summer of 2012. The daily maximum temperature, average temperature, and maximum heat index were compared to identify the most suitable index for this study. A piecewise linear model was used to identify the threshold temperature and the relative risk (RR) above the threshold temperature according to patient characteristics and region.
The total number of patients during the 3 months was 975. Of the three temperature indicators, the daily maximum temperature showed the best goodness of fit with the model. The RR of the total patient incidence was 1.691 (1.641 to 1.743) per 1℃ after 31.2℃. The RR above the threshold temperature of women (1.822, 1.716 to 1.934) was greater than that of men (1.643, 1.587 to 1.701). The threshold temperature was the lowest in the age group of 20 to 64 (30.4℃), and the RR was the highest in the ≥65 age group (1.863, 1.755 to 1.978). The threshold temperature of the provinces (30.5℃) was lower than that of the metropolitan cities (32.2℃). Metropolitan cities at higher latitudes had a greater RR than other cities at lower latitudes.
The influences of temperature on heat-related illnesses vary according to gender, age, and region. A surveillance system and public health program should reflect these factors in their implementation.
Changes in air temperature and its relation to ambulance transports due to heat stroke in all 47 prefectures, in Japan were evaluated.
Data on air temperature were obtained from the Japanese Meteorological Agency. Data on ambulance transports due to heat stroke was directly obtained from the Fire and Disaster Management Agency, Japan. We also used the number of deaths due to heat stroke from the Ministry of Health, Labour and Welfare, Japan, and population data from the Ministry of Internal Affairs and Communications. Chronological changes in parameters of air temperature were analyzed. In addition, the relation between air temperature and ambulance transports due to heat stroke in August 2010 was also evaluated by using an ecological study.
Positive and significant changes in the parameters of air temperature that is, the mean air temperature, mean of the highest air temperature, and mean of the lowest air temperature were noted in all 47 prefectures. In addition, changes in air temperature were accelerated when adjusted for observation years. Ambulance transports due to heat stroke was significantly correlated with air temperature in the ecological study. The highest air temperature was significantly linked to ambulance transports due to heat stroke, especially in elderly subjects.
Global warming was demonstrated in all 47 prefectures in Japan. In addition, the higher air temperature was closely associated with higher ambulance transports due to heat stroke in Japan.
Daily mortality is typically higher on hot days in urban areas, and certain population groups experience disproportionate risk. Air conditioning (AC) has been recommended to mitigate heat-related illness and death. We examined whether AC prevalence explained differing heat-related mortality effects by race. Poisson regression was used to model daily mortality in Chicago, Detroit, Minneapolis, and Pittsburgh. Predictors included natural splines of time (to control seasonal patterns); mean daily apparent temperature on the day of death, and averaged over lags 1–3; barometric pressure; day of week; and a linear term for airborne particles. Separate, city-specific models were fit to death counts stratified by race (Black or White) to derive the percent change in mortality at 29 ºC, relative to 15 ºC (lag 0). Next, city-specific effects were regressed on city-and race-specific AC prevalence. Combined effect estimates across all cities were calculated using inverse variance-weighted averages. Prevalence of central AC among Black households was less than half that among White households in all four cities, and deaths among Blacks were more strongly associated with hot temperatures. Central AC prevalence explained some of the differences in heat effects by race, but room-unit AC did not. Efforts to reduce disparities in heat-related mortality should consider access to AC.
To present recommendations for the prevention and screening, recognition, and treatment of the most common conditions resulting in sudden death in organized sports.
Cardiac conditions, head injuries, neck injuries, exertional heat stroke, exertional sickling, asthma, and other factors (eg, lightning, diabetes) are the most common causes of death in athletes.
These guidelines are intended to provide relevant information on preventing sudden death in sports and to give specific recommendations for certified athletic trainers and others participating in athletic health care.
The short but intense heat wave in mid-July 1995 caused 830 deaths
nationally, with 525 of these deaths in Chicago. Many of the dead were
elderly. and the event raised great concern over why it happened.
Assessment of causes for the heat wave-related deaths in Chicago
revealed many factors were at fault, including an inadequate local heat
wave warning system, power failures, questionable death assessments,
inadequate ambulance service and hospital facilities, the heat island,
an aging population, and the inability of many persons to properly
ventilate their residences due to fear of crime or a lack of resources
for fans or air conditioning. Heat-related deaths appear to be on the
increase in the United States. Heat-related deaths greatly exceed those
caused by other life-threatening weather conditions. Analysis of the
impacts and responses to this heat wave reveals a need to 1) define the
heat island conditions during heat waves for all major cities is a means
to improve forecasts of threatening conditions, 2) develop a nationally
uniform means for classifying heat-related deaths, 3) improve warning
systems that are designed around local conditions of large cities, and
4) increase research on the meteorological and climatological aspects of
heat stress and heat waves.
It is estimated that more than 9000 high school athletes are treated for exertional heat illness annually. Risk factors include being obese and beginning practice during hot and humid weather, when athletes are not yet acclimated to physical exertion in heat.
To describe the epidemiology of exertional heat illness in high school athletes.
National High School Sports-Related Injury Surveillance System data (2005/2006-2010/2011) were analyzed in 2012 to calculate rates and describe circumstances of exertional heat illness.
Exertional heat illness occurred at a rate of 1.20 per 100,000 athlete exposures (95% CI=1.12, 1.28). Exertional heat illnesses were widely distributed geographically, and most occurred in August (60.3%). Of the exertional heat illnesses reported during practice, almost one third (32.0%) occurred more than 2 hours into the practice session. The exertional heat illness rate in football (4.42 per 100,000 athlete exposures) was 11.4 times that in all other sports combined (95% CI=8.3, 15.5, p<0.001). In addition, approximately one third (33.6%) of exertional heat illnesses occurred when a medical professional was not onsite at the time of onset.
Although most exertional heat illnesses occurred in football, athletes in all sports and all geographic areas are at risk. Because exertional heat illness frequently occurs when medical professionals are not present, it is imperative that high school athletes, coaches, administrators, and parents are trained to identify and respond to it. Implementing effective preventive measures depends on increasing awareness of exertional heat illness and relevant preventive and therapeutic countermeasures.
Objective
To assess the symptoms of heat illness experienced by surface mine workers.
Methods
Ninety-one surface mine workers across three mine sites in northern Australia completed a heat stress questionnaire evaluating their symptoms for heat illness. A cohort of 56 underground mine workers also participated for comparative purposes. Participants were allocated into asymptomatic, minor or moderate heat illness categories depending on the number of symptoms they reported. Participants also reported the frequency of symptom experience, as well as their hydration status (average urine colour).
Results
Heat illness symptoms were experienced by 87 and 79 % of surface and underground mine workers, respectively (p = 0.189), with 81–82 % of the symptoms reported being experienced by miners on more than one occasion. The majority (56 %) of surface workers were classified as experiencing minor heat illness symptoms, with a further 31 % classed as moderate; 13 % were asymptomatic. A similar distribution of heat illness classification was observed among underground miners (p = 0.420). Only 29 % of surface miners were considered well hydrated, with 61 % minimally dehydrated and 10 % significantly dehydrated, proportions that were similar among underground miners (p = 0.186). Heat illness category was significantly related to hydration status (p = 0.039) among surface mine workers, but only a trend was observed when data from surface and underground miners was pooled (p = 0.073). Compared to asymptomatic surface mine workers, the relative risk of experiencing minor and moderate symptoms of heat illness was 1.5 and 1.6, respectively, when minimally dehydrated.
Conclusions
These findings show that surface mine workers routinely experience symptoms of heat illness and highlight that control measures are required to prevent symptoms progressing to medical cases of heat exhaustion or heat stroke.
When athletes, warfighters, and laborers perform intense exercise in the heat, the risk of exertional heat stroke (EHS) is ever present. The recent data regarding the fatalities due to EHS within the confines of organized American sport are not promising: during the past 35 years, the highest number of deaths in a 5-year period occurred from 2005 to 2009. This reminds us that, regardless of the advancements of knowledge in the area of EHS prevention, recognition, and treatment, knowledge has not been translated into practice. This article addresses important issues related to EHS cause and care. We focus on the predisposing factors, errors in care, physiology of cold water immersion, and return-to-play or duty considerations.