Received 21 August 2006; received in revised form 19 November 2006; accepted 21 November 2006.
Abstract
Objectives
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°F (range, 88-118°F). At presentation, the mean body temperature was 105.1°F (range, 100.2-111.2°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.
aBanner Good Samaritan Regional Poison, Phoenix, AZ 85006, USA
cArizona College of Osteopathic Medicine, Phoenix, AZ 85308, USA
Corresponding author. Banner Good Samaritan and Maricopa Medical Center, Emergency Medicine, Phoenix, AZ 85006, USA. Tel.: +1 602 239 2358; fax +1 602 239 4138.
This work was previously presented as an oral abstract at SAEM Western Conference 2005, Los Angeles, CA.
ABSTRACT