Comparison between the Bouchama and Japanese Association for Acute Medicine Heatstroke Criteria with Regard to the Diagnosis and Prediction of Mortality of Heatstroke Patients: A Multicenter Observational Study

Yutaka Kondo, Toru Hifumi, Junya Shimazaki, Yasutaka Oda, Shin-ichiro Shiraishi, Kei Hayashida, Tatsuma Fukuda, Masahiro Wakasugi, Jun Kanda, Takashi Moriya, Masaharu Yagi, Takashi Kawahara, Michihiko Tonouchi, Shoji Yokobori, Hiroyuki Yokota, Yasufumi Miyake and Keiki Shimizu
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Yutaka Kondo: Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba 279-0021, Japan
Toru Hifumi: Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo 104-8560, Japan
Junya Shimazaki: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
Yasutaka Oda: Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
Shin-ichiro Shiraishi: Department of Emergency and Critical Care Medicine, Aidu Chuo Hospital, Fukushima 965-8611, Japan
Kei Hayashida: Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo 160-8582, Japan
Tatsuma Fukuda: Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
Masahiro Wakasugi: Emergency and Critical Care Center, Toyama University Hospital, Toyama 930-0152, Japan
Jun Kanda: Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo 173-8606, Japan
Takashi Moriya: Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan
Masaharu Yagi: Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa 901-2132, Japan
Takashi Kawahara: Japan Sport Council, Tokyo 107-0061, Japan
Michihiko Tonouchi: Japan Meteorological Business Support Center, Tokyo 101-0054, Japan
Shoji Yokobori: Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo 113-8603, Japan
Hiroyuki Yokota: Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo 113-8603, Japan
Yasufumi Miyake: Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo 173-8606, Japan
Keiki Shimizu: Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Centre, Tokyo 183-8524, Japan

IJERPH, 2019, vol. 16, issue 18, 1-13

Abstract: Background: This study aims to compare the Bouchama heatstroke (B-HS) and Japanese Association for Acute Medicine heatstroke (JAAM-HS) criteria with regard to the diagnosis and prediction of mortality and neurological status of heatstroke patients. Methods: This multicenter observational study recruited eligible patients from the emergency departments of 110 major hospitals in Japan from 1 July to 30 September, 2014. Results: A total of 317 patients (median age, 65 years; interquartile range, 39–80 years) were included and divided into the B-HS, JAAM-HS, and non-HS groups, with each group consisting of 97, 302, and 15 patients, respectively. The JAAM-HS (1.0; 95% confidence interval [CI], 0.87–1.0) and B-HS (0.29; 95% CI, 0.14–0.49) criteria showed high and low sensitivity to mortality, respectively. Similarly, the JAAM-HS (1.0; 95% CI, 0.93–1.0) and B-HS (0.35; 95% CI, 0.23–0.49) criteria showed high and low sensitivity to poor neurological status, respectively. Meanwhile, the sequential organ failure assessment (SOFA) scores demonstrated good accuracy in predicting mortality among heat-related illness (HRI) patients. However, both JAAM-HS and B-HS criteria could not predict in-hospital mortality. The AUC of the SOFA score for mortality was 0.83 (day 3) among the HRI patients. The patients’ neurological status was difficult to predict using the JAAM-HS and B-HS criteria. Concurrently, the total bilirubin level could relatively predict the central nervous system function at discharge. Conclusions: The JAAM-HS criteria showed high sensitivity to mortality and could include all HRI patients who died. The JAAM-HS criterion was considered a useful tool for judgement of admission at ED. Further investigations are necessary to determine the accuracy of both B-HS and JAAM-HS criteria in predicting mortality and neurological status at discharge.

Keywords: heat related illness; heat stroke; emergency; diagnosis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
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