Clinical Characteristics and Prognosis of Heat Stroke

열사병의 임상적 특징 및 예후에 관한 연구

  • Park, Noh Han (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Ryoo, Hyun Wook (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Seo, Kang Suk (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Park, Jung Bae (Department of Emergency Medicine, School of Medicine, Kyungpook National University) ;
  • Chung, Jae Mung (Department of Emergency Medicine, School of Medicine, Kyungpook National University)
  • 박노한 (경북대학교 의과대학 응급의학교실) ;
  • 류현욱 (경북대학교 의과대학 응급의학교실) ;
  • 서강석 (경북대학교 의과대학 응급의학교실) ;
  • 박정배 (경북대학교 의과대학 응급의학교실) ;
  • 정제명 (경북대학교 의과대학 응급의학교실)
  • Received : 2006.09.18
  • Accepted : 2006.11.13
  • Published : 2006.12.30

Abstract

Purpose: The aim of this study was to evaluate the clinical characteristics of classic heat stroke in Korea and to identify factors of prognosis for heat stroke by comparing a survival group with a non-survival group. Methods: We retrospectively analyzed 27 patients with heat stroke who visited the Emergency Department of Kyungpook National University Hospital from March 2001 to February 2005. First, we divided the patients into two groups, the classic heat stroke group and the exertional heat stroke group, and compared them. Second, we compared the survival group with the non-survival group. Age, sex, cause, place where patients were found, underlying diseases, cooling time, performance of endotracheal intubation, initial Glasgow Coma Scale, initial vital sign, and laboratory findings were reviewed. Results: Five of 27 patients in heat stroke died. The classic heat stroke group had 20 patients. They were old and had more patients in the bathroom than the exertional heat stroke group had. The non-survival group showed lower blood pressure, lower initial GCS score, and higher respiratory rate than the survival group. In laboratory findings, the non-survival group also showed lower$HCO_3-$ level, lower albumin level, lower glucose level, more prolonged PT, and higher CK-MB level than the survival group. Delay in recognition of heat stroke and cooling were poor prognostic factors in heat stroke. Conclusion: The classic heat stroke group had patients who were old and found in the bathroom. Early recognition and treatment of heat stroke is important to reduce mortality. Cooling time, initial GCS score, mean arterial pressure, resipratory rate, $HCO_3-$, PT, CK-MB, and albumin seem to be meaningful when forming a prognosis for heat stroke patients.

Keywords

References

  1. Knochel JP, Reed G. Disorders of heat regulation. In: Narins RG, ed. Maxwell & Kleeman's clinical disorders of fluid and electrolyte metabolism. 5th ed. New York: McGraw-Hill, 1994:1549-90
  2. Patz JA, Campbell-Lendrum D, Holloway T, Foley JA. Impact of regional climate change on human health. Nature 2005;17:310-7
  3. Tintinalli JE, Kelen GD, Stapczynski JS. Emeregency Medicine. A comprehensive study guide. 6th ed. New York: Mcgraw-Hill; 2004. p.1183-90
  4. Dhainaut JF, Claessens YE, Ginsburg C, Riou B. Unprecedented heat-related deaths during the 2003 heat wave in Paris: consequences on emergency departments. Critical care 2004;8:1-2 https://doi.org/10.1186/cc2404
  5. Jo YH, Shin SD, Kim DH, Jo IJ, Rhee JE, Suh GJ, et al. Descriptive study of pro-gnostic facotors of exertional heat stroke in military personal. J Kor Soc Emerg Med 2003;14:409-14
  6. Ha CW, Lee AK, Park JY, Lee KS, Kim SH, Kil KS. Case Report: A CASE of Heatstroke. Kor J Int Med 1971;14:61-7
  7. Kang BS, Lee JH, Song HK, Song KJ, Jeong YK. A Case of Heat Stroke after a Marathon. J Kor Soc Emerg Med 2000;11:390-6
  8. Marx JA, Hockberger RS, Walls RM, Admas J, Barkin RM, Barsan WG, et al. Rosen's Emergeny Medicine. Concepts and Clinical Practice. 5th ed. St. Louis : Mosby; 2002.p.1997-2009
  9. Grogan H, Hopkins PM. Heat stroke: implications for critical care and anaesthesia. Br J Anaesth 2002;88:700-7 https://doi.org/10.1093/bja/88.5.700
  10. Yaqub B, Deeb SA. Heat strokes: aetiopathogenesis, neurological characteristics, treatment and outcome. J Neurol Sci 1998;156:144-51 https://doi.org/10.1016/S0022-510X(98)00037-9
  11. Martinez M, Devenport L, Saussy J, Martinez J. Drug-Associated Heat Stroke. South Med J 2002;95:799-802 https://doi.org/10.1097/00007611-200295080-00006
  12. Bouchama A, Konchel JP. Heat stroke. N Engl J Med 2002;346:1978-88 https://doi.org/10.1056/NEJMra011089
  13. Huang YP, Lin MT, Chen JS, Wu PY. Naltrexone protects against hypotension hypothermia and $\beta$- endorphin overproduction during heatstroke in the rat. J Pharmcol Sci 2005;97:519-24 https://doi.org/10.1254/jphs.FP0040844
  14. Vlikahri R, Heikkonen E, Soukas A. The sauna and alcohol. Ann Clin Res 1988;20:287-91
  15. Vicario SJ, Okabajue R, Haltom T. Rapid cooling in Classic heatstroke : Effect on Mortality Rates. Am J Emerg Med 1986;4:394-8 https://doi.org/10.1016/0735-6757(86)90185-3
  16. Hart GR, Anderson RJ, Crumpler CP, Shulkin A, Reed G, Knochel JP. Epidemic Classic Heat Stroke: Clinical Characteristics and Course of 28 Patients. Medicine. 1982;61:189-97 https://doi.org/10.1097/00005792-198205000-00005
  17. Torre-Cisneros J, Gimenez FP, Pereperez J, Miranda L, Marcos V, Molina V, et al. The early prognostic assesment of heat stroke. Rev Clin Esp 1992;190:439-42
  18. Tek D, Olshaker JS. Heat Illness. Emerg Med Clin North Am 1992;10:299-310
  19. Yaqub BA, Al-Harthi SS, Al-Orainey IO, Laajam MA, Obeid MT. Heat stroke at the Mekkah pilgrimage: clinical characteristics and course of 30 patients. Q J Med 1986;59:523-30
  20. Heled Y, Rav-Acha M, Shani Y, Epstein Y, Moran DS. The “golden hour” for heatstroke treatment. Mil Med 2004;169:184-6 https://doi.org/10.7205/MILMED.169.3.184
  21. Vanhems P, Gambotti L. Excess Rate of In-Hospital Death in Lyons, France, during the August 2003 Heat Wave. N Engl J Med 2003;349:2077-8 https://doi.org/10.1056/NEJM200311203492120
  22. Megarbane B, Resiere D, Shabafrouz K, Duthoit G, Delahaye A, Delerme S, et al. Descriptive study of the patients admitted to an intensive care unit during the heat wave of August 2003 in France. Press Med 2003;32:1690-8
  23. Varghese GM, John G, Thomas K, Abraham OC, Mathai D. Predictors of multi-organ dysfunction in heatstroke. Emerg Med J 2005;22:185-7 https://doi.org/10.1136/emj.2003.009365
  24. Semanza JC, Rubin CH, Falter KH, Selanikio JD, Flanders WD, Howe HL, et al. Heat-Related Deaths during the July 1995 Heat Wave in Chicago. N Engl J Med 1996;335:84-90 https://doi.org/10.1056/NEJM199607113350203
  25. Misset B, Jonghe BD, Bastuji-Garin S, Gattolliat O, Boughrara E, Annane D, et al. Mortality of patients with heatstroke admitted to intensive care units during the 2003 hea wave in France: A national multiple-center risk-factor study. Crit Care Med 2006;34:1087-92 https://doi.org/10.1097/01.CCM.0000206469.33615.02
  26. Alzeer AH, El-Hazmi MA, Warsy AS, Ansari ZA, Yrkendi MS. Serum enzymes in heat stroke: prognostic implication. Clin Chem 1997;43:1182-7