Heat stroke in a subtropical country

Area of Science:

• Environmental Medicine
• Public Health
• Emergency Medicine

Background:

• Heat stroke is considered rare in Taiwan, a subtropical region with no history of heat waves.
• Unusual cases of classic heat stroke were observed in 1998, prompting an investigation into potential causes.

Purpose of the Study:

• To review and collect cases of suspected heat stroke during the summer of 1998 in Taiwan.
• To explore the possible causes of this unusual phenomenon in a region with a low incidence of heat stroke.

Main Methods:

• Retrospective review of emergency department (ED) charts and International Classification of Diseases (ICD) codes.
• Case identification through ED conferences for patients with hyperthermia (>40.6°C), altered mental status, and anhidrosis.
• Analysis of patient demographics, comorbid conditions, social factors, and environmental data during June-August 1998.

Main Results:

• Six cases of heat stroke were identified, occurring during periods of sustained hotter-than-average temperatures.
• Common comorbidities included hypertension (4/6) and pre-existing mental health issues (3/6).
• Patients lived in urban areas, were middle class, avoided air-conditioned rooms, and experienced worse initial outcomes compared to other studies.

Conclusions:

• Classic heat stroke can occur in subtropical regions with low incidence, even without heat waves, during persistently high temperatures due to environmental and social factors.
• Prevention strategies are crucial, including timely public health advisories and education for emergency physicians on recognizing heat stroke during sustained hot weather.