TY - JOUR
T1 - Exertional Heat Stroke and Rhabdomyolysis
T2 - A Medical Record Review and Patient Perspective on Management and Long-Term Symptoms
AU - Kruijt, Nick
AU - van den Bersselaar, L. R.
AU - Hopman, M. T.E.
AU - Snoeck, M. M.J.
AU - van Rijswick, M.
AU - Wiggers, T. G.H.
AU - Jungbluth, H.
AU - Bongers, C. C.W.G.
AU - Voermans, N. C.
N1 - Funding Information:
Several authors of this publication are members of the Netherlands Neuromuscular Center (NL-NMD) and the European Reference Network for rare neuromuscular diseases (EURO-NMD). We would like to thank the RYR-1 foundation for their commitment to spread the knowledge of RYR1 -related manifestations among health care professionals, as well as their support for individuals affected by RYR1 -related conditions. We would like to thank Joost Fonville for his commitment to spread knowledge on exertional heat illnesses, as well as his contribution to the recruitment of participants for the present study through various platforms. We would like to thank medical students Lisa Brandt and Bart van der Leer for their contribution to the design of the study and the data collection.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/5/19
Y1 - 2023/5/19
N2 - Introduction: Exertional heat stroke (EHS) is a medical emergency, occurring when the body generates more heat than it can dissipate, and frequently associated with exertional rhabdomyolysis (ERM). In the present study we aimed to (I) identify clinical features and risk factors, (II) describe current prehospital management, (III) investigate long-term outcomes including the impact on mental health, and review the guidance received during restarting activities. We hope that our approach will improve individual and organizational heat illness preparedness, and improve follow-up care. Methods: We performed a prospective online survey and retrospective medical record review among athletes and military personnel with an episode of EHS/ERM in the Netherlands between 2010 and 2020. We evaluated prehospital management, risk factors, clinical features and long-term outcomes at 6 and 12 months after the event, including mental health symptoms. Furthermore, we investigated what guidance participants received during follow-up, and assessed the patients’ perspective on these outcomes. Results: Sixty participants were included, 42 male (70%) and 18 female (30%), of which 47 presented with EHS (78%) and 13 with ERM (22%). Prehospital management was inconsistent and in the majority of participants not conducted according to available guidelines. Self-reported risk factors included not feeling well-acclimatized to environmental heat (55%) and peer pressure (28%). Self-reported long-term symptoms included muscle symptoms at rest (26%) or during exercise (28%), and neurological sequelae (11%). Validated questionnaires (CIS, HADS and SF-36) were indicative of severe fatigue (30%) or mood/anxiety disorders (11%). Moreover, 90% expressed a lack of follow-up care and that a more frequent and intensive follow-up would have been beneficial for their recovery process. Conclusion: Our findings indicate major inconsistencies in the management of patients with EHS/ERM, emphasizing the compelling need for implementing standardized protocols. Based on the results of long-term outcome measures, we recommend to counsel and evaluate every patient not only immediately after the event, but also in the long-term.
AB - Introduction: Exertional heat stroke (EHS) is a medical emergency, occurring when the body generates more heat than it can dissipate, and frequently associated with exertional rhabdomyolysis (ERM). In the present study we aimed to (I) identify clinical features and risk factors, (II) describe current prehospital management, (III) investigate long-term outcomes including the impact on mental health, and review the guidance received during restarting activities. We hope that our approach will improve individual and organizational heat illness preparedness, and improve follow-up care. Methods: We performed a prospective online survey and retrospective medical record review among athletes and military personnel with an episode of EHS/ERM in the Netherlands between 2010 and 2020. We evaluated prehospital management, risk factors, clinical features and long-term outcomes at 6 and 12 months after the event, including mental health symptoms. Furthermore, we investigated what guidance participants received during follow-up, and assessed the patients’ perspective on these outcomes. Results: Sixty participants were included, 42 male (70%) and 18 female (30%), of which 47 presented with EHS (78%) and 13 with ERM (22%). Prehospital management was inconsistent and in the majority of participants not conducted according to available guidelines. Self-reported risk factors included not feeling well-acclimatized to environmental heat (55%) and peer pressure (28%). Self-reported long-term symptoms included muscle symptoms at rest (26%) or during exercise (28%), and neurological sequelae (11%). Validated questionnaires (CIS, HADS and SF-36) were indicative of severe fatigue (30%) or mood/anxiety disorders (11%). Moreover, 90% expressed a lack of follow-up care and that a more frequent and intensive follow-up would have been beneficial for their recovery process. Conclusion: Our findings indicate major inconsistencies in the management of patients with EHS/ERM, emphasizing the compelling need for implementing standardized protocols. Based on the results of long-term outcome measures, we recommend to counsel and evaluate every patient not only immediately after the event, but also in the long-term.
KW - Athletes
KW - Exercise
KW - Heat-related illnesses
KW - Military personnel
KW - Physical activity
KW - Sequelae
KW - Thermoregulation
UR - http://www.scopus.com/inward/record.url?scp=85160093829&partnerID=8YFLogxK
U2 - 10.1186/s40798-023-00570-y
DO - 10.1186/s40798-023-00570-y
M3 - Article
AN - SCOPUS:85160093829
SN - 2199-1170
VL - 9
JO - Sports Medicine - Open
JF - Sports Medicine - Open
IS - 1
M1 - 33
ER -
