Establishment and effectiveness evaluation of a scoring system for exertional heat stroke by retrospective analysis
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RESEARCH
Open Access
Establishment and effectiveness evaluation of a scoring system for exertional heat stroke by retrospective analysis Meng-Meng Yang1†, Lu Wang2†, Yu Zhang2, Rui Yuan2, Yan Zhao1, Jie Hu1, Fei-Hu Zhou1 and Hong-Jun Kang1*
Abstract Background: Heat stroke (HS) is a serious, life-threatening disease. However, there is no scoring system for HS so far. This research is to establish a scoring system that can quantitatively assess the severity of exertional heat stroke (EHS). Methods: Data were collected from a total of 170 exertional heat stroke (EHS) patients between 2005 and 2016 from 52 hospitals in China. Univariate statistical methods and comparison of the area under the receiver operating characteristic (ROC) curve (AUC) were used to screen exertional heat stroke score (EHSS) parameters, including but not limited body temperature (T), Glasgow Coma Scale (GCS) and others. By comparing the sizes of the AUCs of the APACHE II, SOFA and EHSS assessments, the effectiveness of EHSS in evaluating the prognosis of EHS patients was verified. Results: Through screening with a series of methods, as described above, the present study determined 12 parameters – body temperature (T), GCS, pH, lactate (Lac), platelet count (PLT), prothrombin time (PT), fibrinogen (Fib), troponin I (TnI), aspartate aminotransferase (AST), total bilirubin (TBIL), creatinine (Cr) and acute gastrointestinal injury (AGI) classification – as EHSS parameters. It is a 0–47 point system designed to reflect increasing severity of heat stroke. Low (EHSS< 20) and high scores (EHSS> 35) showed 100% survival and 100% mortality, respectively. We found that AUCEHSS > AUCSOFA > AUCAPACHE II. Conclusion: A total of 12 parameters – T, GCS, pH, Lac, PLT, PT, Fib, TnI, AST, TBIL, Cr and gastrointestinal AGI classification – are the EHSS parameters with the best effectiveness in evaluating the prognosis of EHS patients. As EHSS score increases, the mortality rate of EHS patients gradually increases. Keywords: Exertional heat stroke, Scoring system, Prognosis, Effectiveness of evaluation
Background Heat stroke (HS) is a serious, life-threatening disease characterized by elevated core body temperature that is simultaneously accompanied by central nervous system (CNS) dysfunction [1]. The disease is often accompanied by multiple-organ dysfunction [2, 3]. HS is * Correspondence: [email protected]; [email protected] † Meng-Meng Yang and Lu Wang contributed equally to this work. 1 Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing 100853, China Full list of author information is available at the end of the article
mainly divided into two types: classical heat stroke (CHS) and exertional heat stroke (EHS). The former more frequently occurs in children and the elderly, who are exposed to high temperatures, while the latter mostly occurs in healthy young populations who are engaged in high-intensity manual labor, including soldiers, athletes, workers and fa
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