title: Fatal heat stroke in children found in parked cars: autopsy findings.
abstract: A common and unfortunate cause for heat stroke-related deaths in children is entrapment in closed vehicles. The aim of this study was to analyze the pathological consequences of such grave events. Autopsy reports of all children that were brought to a national forensic medicine center after being found dead in closed vehicles over a 21-year period (1995-2015) were reviewed. Data extracted were the circumstances of the events, child age, sex, height and weight, time, date and duration of entrapment, and environmental temperatures at the time of entrapment and the autopsy findings. Eight deceased children were brought to the forensic medicine center for autopsy, and seven families consented to the procedure. Autopsy findings included diffuse petechiae and hemorrhages of serosal membranes (n = 7/7) and lung congestion (n = 3/7).
  
  
  CONCLUSIONS
  Typical autopsy findings following classical heat stroke in children include diffuse petechiae and hemorrhages and lung involvement. These findings are similar to those reported in adults that had died following exertional heat stroke-a very different mechanism of heat accumulation. Prevention of future events can possibly be obtained by public education on the rapid heating of closed vehicles, the vulnerability of children to heat, and the caregiver role in child entrapment.
  
  
  BACKGROUND
  • A common and unfortunate cause for heat stroke-related deaths in children is entrapment in closed vehicles. The pathological consequences of such grave events have not been previously reported. What is New: • This study is the first to describe autopsy findings from children who were found dead in parked cars. • Autopsy findings included diffuse petechiae hemorrhages of serosal membranes and lung congestion. • These findings are identical to those seen in adults following exertional heat stroke.
authors.affiliation: Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Berliz
authors.initials: B
authors.lastname: Adato
authors.affiliation: The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, 52621, Israel. gal.dubnov-raz@sheba.health.gov.il.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. gal.dubnov-raz@sheba.health.gov.il.
authors.forename: Gal
authors.identifier: http://orcid.org/0000-0003-1469-8043
authors.initials: G
authors.lastname: Dubnov-Raz
authors.affiliation: Israel National Center of Forensic Medicine, Tel Aviv, Israel.
authors.forename: Hadas
authors.initials: H
authors.lastname: Gips
authors.affiliation: Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yuval
authors.initials: Y
authors.lastname: Heled
authors.affiliation: Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Epstein
mesh_terms: D001336:Automobiles; D001344:Autopsy; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D018883:Heat Stroke / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies
keywords: Automobile; Autopsy; Death; Heat stroke; Pediatrics