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The Association Between Central Nervous System Function and Core Body Temperature in Patients With Exertional Heat
Susan W Yeargin1, Samantha E Scarneo-Miller2, John Jardine3
1Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
Objective:
Describe central nervous system (CNS) function using the Glasgow Coma Scale (GCS) and a description of signs and symptoms in patients with exertional heat stroke (EHS) during the course of treatment at a warm-weather road race. Determine whether a relationship exists between rectal temperature (T re ) and the GCS in patients with EHS during treatment.
Design:
Cross-sectional research design retrospectively using medical charts.
Setting:
Eleven-kilometer road race medical tent.
Patients:
Patients (n = 25) with EHS receiving treatment.
Interventions:
Dedicated scribes recorded patient vitals on a medical chart. The deidentified medical charts were provided by the medical director after the race. A Spearman rank correlation was used to determine whether a relationship existed between Tre and GCS (subscales and cumulative).
Main Outcome Measures:
Rectal temperature was measured using an in-dwelling flexible probe with temperatures recorded approximately every 3 minutes. GCS was recorded by subscales on the medical chart by scribes according to existing word anchors.
Results:
Average initial T re was 41.0 ± 0.6°C (105.8 ± 1.1°F) and cumulative GCS score was 14 ± 3 (4-15). No single CNS dysfunction predominated across most observations. Confusion had the highest recorded percentage (19.8%). There was a significant but weak correlation between T re and GCS [r s (124) = -0.255, P = 0.004; Ρ 2 = 0.06]. For time points in which Tre was >40°C, there was no correlation between Tre and GCS [r s (60) = -0.209, P = 0.108; Ρ 2 = 0.04], and GCS subscales Eye [r s (60) = -0.230, P = 0.077; Ρ 2 = 0.05], Verbal [r s (60) = -0.183, P = 0.161; Ρ 2 = 0.03], and Motor [r s (60) = -0.214, P = 0.100; Ρ 2 = 0.05].
Conclusions:
Although GCS is a good global measure, it may not be appropriate in capturing how CNS dysfunction presents in patients with EHS. Clinicians should continue to use clinical CNS dysfunction and T re to initially recognize EHS, however, T re should be used to guide prehospital cooling of patients with EHS.
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