scholarly journals Incidence of Recurrent Exertional Heat Stroke in a Warm-Weather Road Race

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 720
Author(s):  
Rebecca L. Stearns ◽  
Yuri Hosokawa ◽  
William M. Adams ◽  
Luke N. Belval ◽  
Robert A. Huggins ◽  
...  
Keyword(s):  
Relative Risk ◽  
Risk Ratio ◽  
Heat Stroke ◽  
Case Series ◽  
Relative Risk Ratio ◽  
Future Research ◽  
Exertional Heat Stroke ◽  
Warm Weather ◽  
Before And After ◽  
Road Race

Background and Objectives: Exertional heat stroke (EHS) survivors may be more susceptible to subsequent EHS; however, the occurrence of survivors with subsequent EHS episodes is limited. Therefore, the purpose of this study was to evaluate the incidence of participants with repeated EHS (EHS-2+) cases in a warm-weather road race across participation years compared to those who experienced 1 EHS (EHS-1). Materials and Methods: A retrospective observational case series design was utilized. Medical record data from 17-years at the Falmouth Road Race between 2003–2019 were examined for EHS cases. Incidence of EHS-2+ cases per race and average EHS cases per EHS-2+ participant were calculated (mean ± SD) and descriptive factors (rectal temperature (TRE), finish time (FT), Wet Bulb Globe Temperature (WBGT), age, race year) for each EHS was collected. Results: A total of 333 EHS patients from 174,853 finishers were identified. Sixteen EHS-2+ participants (11 males, 5 females, age = 39 ± 16 year) accounted for 11% of the total EHS cases (n = 37/333). EHS-2+ participants had an average of 2.3 EHS cases per person (range = 2–4) and had an incidence rate of 2.6 EHS per 10 races. EHS-2+ participants finished 93 races following initial EHS, with 72 of the races (77%) completed without EHS incident. Initial EHS TRE was not statistically different than subsequent EHS initial TRE (+0.3 ± 0.9 °C, p > 0.050). Initial EHS-2+ participant FT was not statistically different than subsequent EHS FT (−4.2 ± 7.0 min, p > 0.050). The years between first and second EHS was 3.6 ± 3.5 year (Mode: 1, Range: 1–12). Relative risk ratios revealed that EHS patients were at a significantly elevated risk for subsequent EHS episodes 2 years following their initial EHS (relative risk ratio = 3.32, p = 0.050); however, the risk from 3–5 years post initial EHS was not statistically elevated, though the relative risk ratio values remained above 1.26. Conclusions: These results demonstrate that 11% of all EHS cases at the Falmouth Road Race are EHS-2+ cases and that future risk for a second EHS episode at this race is most likely to occur within the first 2 years following the initial EHS incident. After this initial 2-year period, risk for another EHS episode is not significantly elevated. Future research should examine factors to explain individuals who are susceptible to multiple EHS cases, incidence at other races and corresponding prevention strategies both before and after initial EHS.

scholarly journals An Exertional Heat Stroke Survivor’s Return to Running: An Integrated Approach on Treatment, Recovery, and Return to Activity

2016 ◽  
Vol 25 (3) ◽  
pp. 280-287 ◽  
Author(s):  
William M. Adams ◽  
Yuri Hosokawa ◽  
Robert A. Huggins ◽  
Stephanie M. Mazerolle ◽  
Douglas J. Casa
Keyword(s):  
Best Practices ◽  
Heat Stroke ◽  
Predisposing Factors ◽  
Hydration Status ◽  
Evidence Based ◽  
Exertional Heat Stroke ◽  
Warm Weather ◽  
Road Race ◽  
Return To Activity

Context:Evidence-based best practices for the recognition and treatment of exertional heat stroke (EHS) indicate that rectal thermometry and immediate, aggressive cooling via cold-water immersion ensure survival from this medical condition. However, little is known about the recovery, medical follow-up, and return to activity after an athlete has suffered EHS.Objective:To highlight the transfer of evidenced-based research into clinical practice by chronicling the treatment, recovery, and return to activity of a runner who suffered an EHS during a warm-weather road race.Design:Case study.Setting:Warm-weather road race.Participant:53-y-old recreationally active man.Intervention:A runner’s treatment, recovery, and return to activity from EHS and 2014 Falmouth Road Race performance.Main Outcomes:Runner’s perceptions and experiences with EHS, body temperature, heart rate, hydration status, exercise intensity.Results:The runner successfully completed the 2014 Falmouth Road Race without incident of EHS. Four dominant themes emerged from the data: predisposing factors, ideal treatment, lack of medical follow-up, and patient education. The first theme identified 3 predisposing factors that contributed to the runner’s EHS: hydration, sleep loss, and lack of heat acclimatization. The runner received ideal treatment using evidence-based best practices. A lack of long-term medical care following the EHS with no guidance on the runner’s return to full activity was observed. The runner knew very little about EHS before the 2013 race, which drove him to seek knowledge as to why he suffered EHS. Using this newly learned information, he successfully completed the 2014 Falmouth Road Race without incident.Conclusions:This case supports prior literature examining the factors that predispose individuals to EHS. Although evidence-based best practices regarding prompt recognition and treatment of EHS ensure survival, this case highlights the lack of medical follow-up and physician-guided return to activity after EHS.

Relative-risk ratio was a useful measure of differential association in cohort and case-series studies

2007 ◽  
Vol 60 (4) ◽  
pp. 361-365 ◽  
Author(s):  
M.N. Hocine ◽  
P. Tubert-Bitter ◽  
T. Moreau ◽  
M. Chavance ◽  
E. Varon ◽  
...  
Keyword(s):  
Relative Risk ◽  
Risk Ratio ◽  
Case Series ◽  
Differential Association ◽  
Relative Risk Ratio

Effectiveness of Cold Water Immersion in the Treatment of Exertional Heat Stroke at the Falmouth Road Race

2015 ◽  
Vol 47 (2) ◽  
pp. 240-245 ◽  
Author(s):  
JULIE K. DEMARTINI ◽  
DOUGLAS J. CASA ◽  
REBECCA STEARNS ◽  
LUKE BELVAL ◽  
ARTHUR CRAGO ◽  
...  
Keyword(s):  
Cold Water ◽  
Water Immersion ◽  
Heat Stroke ◽  
Cold Water Immersion ◽  
Exertional Heat Stroke ◽  
Road Race

Exertional Heat Illness: Emerging Concepts and Advances in Prehospital Care

2015 ◽  
Vol 30 (3) ◽  
pp. 297-305 ◽  
Author(s):  
Riana R. Pryor ◽  
Ronald N. Roth ◽  
Joe Suyama ◽  
David Hostler
Keyword(s):  
Heat Stress ◽  
Prehospital Care ◽  
Water Immersion ◽  
Heat Stroke ◽  
Case Series ◽  
Whole Body ◽  
Heat Illness ◽  
Publication Type ◽  
Exertional Heat Stroke ◽  
Exertional Heat Illness

AbstractExertional heat illness is a classification of disease with clinical presentations that are not always diagnosed easily. Exertional heat stroke is a significant cause of death in competitive sports, and the increasing popularity of marathons races and ultra-endurance competitions will make treating many heat illnesses more common for Emergency Medical Services (EMS) providers. Although evidence is available primarily from case series and healthy volunteer studies, the consensus for treating exertional heat illness, coupled with altered mental status, is whole body rapid cooling. Cold or ice water immersion remains the most effective treatment to achieve this goal. External thermometry is unreliable in the context of heat stress and direct internal temperature measurement by rectal or esophageal probes must be used when diagnosing heat illness and during cooling. With rapid recognition and implementation of effective cooling, most patients suffering from exertional heat stroke will recover quickly and can be discharged home with instructions to rest and to avoid heat stress and exercise for a minimum of 48 hours; although, further research pertaining to return to activity is warranted.PryorRR,RothRN,SuyamaJ,HostlerD.Exertional heat illness: emerging concepts and advances in prehospital care.Prehosp Disaster Med.2015;30(3):19.

Cold-Water Dousing with Ice Massage to Treat Exertional Heat Stroke: A Case Series

2009 ◽  
Vol 80 (8) ◽  
pp. 720-722 ◽  
Author(s):  
Brendon P. McDermott ◽  
Douglas J. Casa ◽  
Francis G. O’Connor ◽  
William B. Adams ◽  
Lawrence E. Armstrong ◽  
...  
Keyword(s):  
Cold Water ◽  
Heat Stroke ◽  
Case Series ◽  
Exertional Heat Stroke

Efficacité du pré-signalement d'arrêt scolaire avec feux jaunes et avec feux de détresse

2002 ◽  
Vol 29 (3) ◽  
pp. 475-483
Author(s):  
Jean-François Bruneau ◽  
Denis Morin ◽  
Marcel Pouliot
Keyword(s):  
Relative Risk ◽  
Risk Ratio ◽  
Relative Effectiveness ◽  
Video Camera ◽  
Efficiency Index ◽  
Relative Risk Ratio ◽  
School Bus ◽  
School Buses ◽  
Light System ◽  
Yellow Lights

The pre-stop warning is activated by the bus drivers to warn motorists that the school bus will soon stop, requiring all vehicles to stop. On buses equipped with an eight-light system, four yellow flashing lights, located near the roof, precede the four red flashing lights activated with the stop-arm. In Québec, where pre-stop warning is not required, it is permitted to use the "hazard lights" as a pre-stop signal, when the school bus has red lights only. This study rates the relative effectiveness of the two systems, in fall and spring time. Advance signal lights are tested on the same routes : two- and four-lane rural or near urban highways, with high posted speeds (70 km/h and over). A video camera is aimed at oncoming traffic along with a radar antenna. Changes in drivers' speeds are studied with a relative risk ratio and an efficiency index, validated through expected frequencies. The eight-light system reduced significantly the rate of illegal passing and the overall speed during advance signal. The eight-light system was more effective than the hazard lights for all tested parameters, including visibility, traffic, weather, and season. The near-roof position of the yellow lights probably explains the gap between the two systems.Key words: advance signalling device, pre-stop warning, eight-light system, amber lights, hazard lights, school buses, illegal passing, speed, relative risk ratio, road safety, rural area.

scholarly journals Multiple Social Vulnerabilities to Health Disparities and Hypertension and Death in the REGARDS Study

Hypertension ◽  
2021 ◽  
Author(s):  
Jordan B. King ◽  
Laura C. Pinheiro ◽  
Joanna Bryan Ringel ◽  
Adam P. Bress ◽  
Daichi Shimbo ◽  
...  
Keyword(s):  
Relative Risk ◽  
Racial Differences ◽  
Risk Ratio ◽  
Social Vulnerability ◽  
Economic Education ◽  
Community Context ◽  
Relative Risk Ratio ◽  
Adjusted Relative Risk ◽  
Regards Study ◽  
Social Vulnerabilities

Social vulnerabilities increase the risk of developing hypertension and lower life expectancy, but the effect of an individual’s overall vulnerability burden is unknown. Our objective was to determine the association of social vulnerability count and the risk of developing hypertension or dying over 10 years and whether these associations vary by race. We used the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) and included participants without baseline hypertension. The primary exposure was the count of social vulnerabilities defined across economic, education, health and health care, neighborhood and built environment, and social and community context domains. Among 5425 participants of mean age 64±10 SD years of which 24% were Black participants, 1468 (31%) had 1 vulnerability and 717 (15%) had ≥2 vulnerabilities. Compared with participants without vulnerabilities, the adjusted relative risk ratio for developing hypertension was 1.16 (95% CI, 0.99–1.36) and 1.49 (95% CI, 1.20–1.85) for individuals with 1 and ≥2 vulnerabilities, respectively. The adjusted relative risk ratio for death was 1.55 (95% CI, 1.24–1.93) and 2.30 (95% CI, 1.75–3.04) for individuals with 1 and ≥2 vulnerabilities, respectively. A greater proportion of Black participants developed hypertension and died than did White participants (hypertension, 38% versus 31%; death, 25% versus 20%). The vulnerability count association was strongest in White participants ( P value for vulnerability count×race interaction: hypertension=0.046, death=0.015). Overall, a greater number of socially determined vulnerabilities was associated with progressively higher risk of developing hypertension, and an even higher risk of dying over 10 years.

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