The Association Between Central Nervous System Function and Core Body Temperature in Patients With Exertional Heat...

Area of Science:

• Sports Medicine
• Environmental Physiology
• Emergency Medicine

Background:

• Exertional heat stroke (EHS) is a critical medical emergency characterized by central nervous system (CNS) dysfunction.
• The Glasgow Coma Scale (GCS) is commonly used to assess neurological status, but its utility in EHS requires further investigation.
• Understanding the relationship between core body temperature and neurological impairment is crucial for effective EHS management.

Purpose of the Study:

• To describe CNS function using GCS and associated signs/symptoms in patients treated for EHS at a road race.
• To determine the correlation between rectal temperature (Tre) and GCS scores in EHS patients during treatment.

Main Methods:

• Retrospective cross-sectional study utilizing deidentified medical charts from 25 EHS patients treated at an 11-km road race.
• Rectal temperature (Tre) was recorded approximately every 3 minutes using an in-dwelling probe.
• Glasgow Coma Scale (GCS) was documented by trained scribes, including subscale scores and cumulative scores, using established anchors.

Main Results:

• The average initial Tre was 41.0 ± 0.6°C (105.8 ± 1.1°F); the average cumulative GCS score was 14 ± 3.
• Confusion was the most frequent CNS dysfunction observed (19.8%).
• A significant but weak negative correlation was found between Tre and GCS (rs = -0.255, P = 0.004). No significant correlation was observed when Tre was above 40°C.

Conclusions:

• While GCS is a global neurological assessment tool, it may not fully capture the spectrum of CNS dysfunction in EHS.
• Clinicians should rely on clinical assessment of CNS dysfunction and Tre for initial EHS recognition.
• Rectal temperature (Tre) is a critical parameter to guide prehospital cooling interventions for EHS patients.