Research Article Advance Publication
Summertime Acute Heat Illness in U.S. Emergency Departments from 2006 through 2010: Analysis of a Nationally Representative Sample
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Citation: Hess JJ, Saha S, Luber G. Summertime Acute Heat Illness in U.S. Emergency Departments from 2006 through 2010: Analysis of a Nationally Representative Sample. Environ Health Perspect; http://dx.doi.org/10.1289/ehp.1306796.
Received: 13 March 2013
Accepted: 16 June 2014
Advance Publication: 17 June 2014
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Background: Patients with acute heat illness present primarily to emergency departments (EDs), yet little is known regarding these visits.
Objective: To describe acute heat illness visits to US EDs from 2006-2010 and identify factors associated with hospital admission or death-in-the-ED.
Methods: We extracted ED case-level data from the Nationwide Emergency Department Sample (NEDS) for 2006-10, defining cases as ED visits from May-September with any heat illness diagnosis (ICD-9-CM 992.0-992.9). We correlated visit rates and temperature anomalies analyzed demographics and ED disposition, identified risk factors for adverse outcomes, and examined ED case fatality rates (CFR).
Results: There were 326,497 (95% CI: 308,372-344,658) cases, with 287,875 (88.2%) treated-and-released, 38,392 (11.8%) admitted, and 230 (0.07%) died-in-the-ED. Heat illness diagnoses were first-listed in 68%. 74.7% had heat exhaustion, 5.4% heat stroke. Visit rates were highly correlated with annual temperature anomalies (correlation coefficient 0.90, p=0.037). Treat-and-release rates were highest for younger adults (26.2/100,000/year), while hospitalization and death-in-the-ED rates were highest for older adults (6.7 and 0.03/100,000/year respectively); all rates were highest in rural areas. Heat stroke had an ED CFR of 99.4/10,000 (78.7-120.1) visits and was diagnosed in 77.0% of deaths. Adjusted odds of hospital admission or death-in-the-ED were higher among elders, males, urban and low income residents, and those with chronic conditions.
Conclusions: Heat illness presented to the ED frequently, with highest rates in rural areas. Case definitions should include all diagnoses. Visit rates were correlated with temperature anomalies. Heat stroke had a high ED CFR. Males, elders, and the chronically ill were at greatest risk of admission or death-in-the-ED. Chronic disease burden exponentially increased this risk.
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