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Classic heat stroke in a desert climate: A systematic review of 2632 cases
Saber Yezli1,2,3, Yara Yassin1, Sujoud Ghallab1
1Biostatistics, Epidemiology and Scientific Computing Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Insights
Classic heat stroke (HS) is characterized by extreme hyperthermia and loss of consciousness, leading to multiorgan injury. Prompt recognition and treatment are crucial to prevent rapid progression to organ failure and death.
Area of Science:
- Environmental and Occupational Health
- Emergency Medicine
- Critical Care Medicine
Background:
- Classic heat stroke (HS) is an ancient condition with uncertain early clinical manifestations, natural course, and complications.
- Understanding HS is critical, especially in vulnerable populations and extreme environments like the Hajj pilgrimage.
Approach:
- A systematic review of 44 studies involving 2632 patients with HS was conducted.
- Data from MEDLINE, Embase, Web of Science, SCOPUS, and CINAHL databases (inception to April 2022) were synthesized using pooled descriptive statistics.
Key Points:
- Prevalent risk factors for HS include overweight/obesity, diabetes, and cardiovascular disease.
- Dominant clinical features are extreme hyperthermia (mean 42.0°C), hot/dry skin, and severe loss of consciousness (GCS <8 in 53.8%).
- Early complications include hypotension, rhabdomyolysis, acute kidney/liver/heart injury, and coagulopathy, with elevated stress hormones and inflammatory markers.
Conclusions:
- Heat stroke rapidly induces multiorgan injury, potentially progressing to organ failure.
- A pooled case fatality rate of 5.6% highlights the severity of HS.
- Timely recognition and treatment are essential to improve outcomes and prevent mortality.
Background:
Although classic heat stroke (HS) is one of the most ancient conditions known to humans, the description of its early clinical manifestations, natural course, and complications remains uncertain.
Objectives:
A systematic review of the demographics, clinical characteristics, biomarkers, therapy, and outcomes of HS during the Muslim (Hajj) pilgrimage in the desert climate of Mecca, Saudi Arabia.
Methods:
We searched the MEDLINE, Embase, Web of Science Core Collection, SCOPUS, and CINAHL databases from inception to April 2022. We summarized the data from eligible studies and synthesized them in narrative form using pooled descriptive statistics.
Results:
Forty-four studies, including 2632 patients with HS, met the inclusion criteria. Overweight or obesity, diabetes, and cardiovascular disease were prevalent among cases of HS. Evidence suggests that extreme hyperthermia (pooled mean = 42.0°C [95% confidence interval (CI): 41.9, 42.1], range 40-44.8°C) with hot and dry skin (>99% of cases) and severe loss of consciousness (mean Glasgow Coma Scale <8 in 53.8% of cases) were the dominant clinical characteristics of classic HS. Hypotension, tachypnea, vomiting, diarrhea, and biochemical biomarkers indicating mild-to-moderate rhabdomyolysis, acute kidney, liver, heart injury, and coagulopathy were frequent at the onset. Concomitantly, stress hormones (cortisol and catecholamines) and biomarkers of systemic inflammation and coagulation activation were increased. HS was fatal in 1 in 18 cases (pooled case fatality rate = 5.6% [95%CI: 4.6, 6.5]).
Conclusions:
The findings of this review suggest that HS induces an early multiorgan injury that can progress rapidly to organ failure, culminating in death, if it is not recognized and treated promptly.
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