Hospital Mistreatment Added to Heat Stroke Deaths
Monitor Wire Services
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Monitor Wire Services |
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A new analysis
of deaths from a 1995 Chicago heat wave finds that medical professionals and hospitals badly mishandled treatment of heat stroke, and 50 percent more people died than was reported at the time.
Although the estimates of heat-related deaths was already high-- more than 600 excess deaths in nine days -- the study shows that an additional 50 percent of the patients admitted to Chicago-area hospitals for heat stroke died within a year, 21 percent of them even before release from the hospital. Another one-third had severe functional impairment at discharge, and none of them had improved after one year. With the sick overwhelming Chicago emergency rooms, few patients received optimal treatment: immersion in cool or ice water within 30 minutes. Just one of the 58 patients in this study was properly cooled within the recommended time. "Because they presented with altered mental status, many of these patients were sent for head CT scans, delaying aggressive cooling measures," explained Maurice Ndukwu, M.D., assistant professor of medicine at the University of Chicago Medical Center and lead author of the study. "But the information gained from these scans did not contribute to patient management." "Unlike previous descriptions of classic heat stroke, most of the patients in this study suffered from multi-system organ dysfunction, including neurologic impairment" said Ndukwu. "For many patients, that dysfunction persisted long after discharge." |
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Physicians
classify heat stroke as 'exertional,' triggered in healthy people
by intense activity in very hot and humid weather, or 'classic,' which
usually strikes the inactive ill or elderly during prolonged heat. In this
study, most patients with classic heat stroke suffered the more profound
health consequences associated primarily with exertional heat stroke. They
were more likely to suffer brain, kidney, and cardiovascular damage,
previously considered rare in classic heat stroke.
Unlike previous studies of classic heat stroke, Ndukwu's team found that two out of three patients developed kidney problems. Almost half had abnormalities in blood clotting, which could contribute to subsequent liver and lung damage. They also found an unexpectedly high rate (57 percent) of pre-existing infections in patients requiring ICU care, placing these patients at additional risk. "In this unusual episode, we saw sicker patients with more severe disease than is customary. It taught us that classic heat stroke is a deadly disorder, more complex, more often fatal and more permanently disabling than the literature on this disorder would predict. And it drove home the crucial importance of prevention and rapid diagnosis and treatment." This study followed every patient at half of the area's 24 hospitals with classic heat stroke severe enough to require ICU care. The findings are reported in the August 1 issue of the Annals of Internal Medicine.
Albion Monitor August 3, 1998 (http://www.monitor.net/monitor)
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