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

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.