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Research Article Advance Publication

Environ Health Perspect; DOI:10.1289/ehp.1306796

Summertime Acute Heat Illness in U.S. Emergency Departments from 2006 through 2010: Analysis of a Nationally Representative Sample

Jeremy J. Hess,1,2,3 Shubhayu Saha,1 and George Luber1
Author Affiliations close
1Climate and Health Program, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; 2Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; 3Department of Environmental Health, Rollins School of Public Health at Emory University, Atlanta, Georgia, USA
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This EHP Advance Publication article has been peer-reviewed, revised, and accepted for publication. EHP Advance Publication articles are completely citable using the DOI number assigned to the article. This document will be replaced with the copyedited and formatted version as soon as it is available. Through the DOI number used in the citation, you will be able to access this document at each stage of the publication process.

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;

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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