Outcomes after environmental hyperthermia.
OBJECTIVE
This study was conducted to describe the characteristics and outcomes of patients who presented to the emergency department (ED) with presumed environmental hyperthermia.


METHODS
A retrospective chart review was performed in 2 institutions with patients who were seen in the ED and had a discharge diagnosis of hyperthermia, heat stroke, heat exhaustion, or heat cramps. Exclusion criteria were an alternative diagnosis potentially explaining the hyperthermia (pneumonia, etc). Research assistants, who were blinded to the purpose of the study, performed a systematic chart review after a structured training session. If necessary, a third reviewer acted as a tiebreaker. Data regarding patient demographics, comorbidities, vital signs, laboratory results, and short-term outcome were collected. Data were analyzed with Excel and STATA software.


RESULTS
We enrolled 52 patients with a mean age of 42.6 years (range, 0.4-81 years) from August 1, 2003 to August 31, 2005. The mean high daily temperature was 103.6 degrees F (range, 88-118 degrees F). At presentation, the mean body temperature was 105.1 degrees F (range, 100.2-111.2 degrees F) and the Glasgow Coma Scale score was less than 14 in 36 (69.2%) patients. Laboratory results demonstrated that 21 (40.4%) patients had a creatinine level of more than 1.5 mg/dL, 35 (67.3%) patients had a creatine kinase (CK) of more than 200 U/L, 30 patients (57.7%) had a prothrombin time of more than 13 seconds, 29 (55.8%) patients had an aspartate aminotransferase (AST) of more than 45 U/L, and only 3 patients (5.7%) had a glucose of less than 60 mg/dL. Ethanol or illicit drugs were involved in 18 (34.6%) cases. The mean hospital stay was 4.7 days (range, 1-30 days), and there were 15 deaths (28.8%). A kappa score for interreviewer reliability was 0.69. Major limitations were the retrospective nature and lack of homogeneity in patient evaluation and test ordering.


CONCLUSIONS
Hyperthermic patients with higher initial temperatures, hypotension, or low Glasgow Coma Scale score were more likely to die.
LoVecchio
Frank
F
Banner Good Samaritan Regional Poison, Phoenix, AZ 85006, USA. frank.lovecchio@bannerhealth.com
Pizon
Anthony F
AF
Berrett
Christopher
C
Balls
Adam
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001130:Arizona / Q000453:epidemiology; D001219:Aspartate Aminotransferases / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D001831:Body Temperature; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D015600:Glasgow Coma Scale; D018882:Heat Stress Disorders / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D011517:Prothrombin Time; D012189:Retrospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D016019:Survival Analysis
D001786:Blood Glucose; D003404:Creatinine; D001219:Aspartate Aminotransferases