Challenging Return to Play Decisions

Asplund, Chad; O’Connor, Francis G.

doi:10.1177/1941738115617453

Cited by 34 publications

(19 citation statements)

References 46 publications

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“…In non-fatal cases, the time course of biochemical recovery has not been well-described. An improved understanding of EHS pathophysiology, etiology and the factors that influence recovery will improve decision making regarding treatment, and return to activity [25].…”

Section: Introductionmentioning

confidence: 99%

Biochemical recovery from exertional heat stroke follows a 16-day time course

et al. 2020

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BackgroundThe aim of this study was to characterize the time-resolved progression of clinical laboratory disturbances days-following an exertional heat stroke (EHS). Currently, normalization of organ injury clinical biomarker values is the primary indicator of EHS recovery. However, an archetypical biochemical recovery profile following EHS has not been established. MethodsWe performed a retrospective analysis of EHS patient records in US military personnel from 2008-2014 using the Military Health System Data Repository (MDR). We focused on commonly reported clinical laboratory analytes measured on the day of injury and all proceeding follow-up visits. ResultsOver the prescribed period, there were 2,529 EHS episodes treated at 250 unique treatment locations. Laboratory results, including a standardized set of blood, serum and urine assays, were analyzed from 0-340 days following the initial injury. Indicators of acute kidney injury, including serum electrolyte disturbances and abnormal urinalysis findings, were most prevalent on the day of the injury but normalized within 24-48hours (creatinine, blood urea nitrogen, and blood and protein in urine). Muscle damage and liver function-associated markers peaked 0-4 days after injury and persisted outside their respective reference ranges for 2-16 days (alanine aminotransferase, aspartate aminotransferase, creatine phosphokinase, myoglobin, prothrombin time). ConclusionBiochemical recovery from EHS spans a 16-day time course, and markers of end-organ damage exhibit distinct patterns over this period. This analysis underscores the prognostic value of each clinical laboratory analyte and will assist in evaluating EHS patient presentation, injury severity and physiological recovery.

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Section: Introductionmentioning

confidence: 99%

Biochemical recovery from exertional heat stroke follows a 16-day time course

et al. 2020

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“…The NCAA requires all athletes to provide documentation of prior sickle cell testing, undergo testing, or sign an opt-out provision (1). Previously, only the Air Force, Navy, and Marine Corps required testing of all their members (2,3). However, in 2020, the Army initiated mandatory SCT testing for incoming recruits and for all other current members during their periodic health assessment (4).…”

Section: Discussionmentioning

confidence: 99%

“…A detailed medical history should try to identify comorbidities or risk factors that may have predisposed the athlete to the event. A graded return to play should be monitored and the athlete should be educated on the importance of hydration and exhibit caution during periods of high temperature or altitude (2). In a similar manner, EHS patients should not return to activity until they are asymptomatic and laboratory values are within normal limits (2).…”

Section: Discussionmentioning

confidence: 99%

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Hornsby¹

2023

Curr Sports Med Rep

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“…Decision making in determining when it is safe to return to duty (in the military) or play (in athletes) after EHS also remains contentious [6]. Shedding light on underlying pathophysiological cardiac processes undetectable in current "Return To Play Heat Tolerance Testing" will optimize this decision-making process, and subsequent medical follow up [6,15]. In this literature review, we will aim to prove the association of heatstroke and delayed cardiovascular diseases, including a look at the possible underlying pathophysiology.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Cardiovascular Diseases of Heatstroke: A Delayed Pathophysiology Outcome

Nzvere

Tariq

Nishanth

et al. 2020

Cureus

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Heatstroke, defined as an elevated core body temperature above 40°C accompanied by altered mental status (e.g., confusion, disorientation, seizure and coma), is the most severe and lifethreatening condition in the spectrum of heat-related illnesses. Heatstroke patients may present with multi-organ dysfunction, but with rapid cooling and organ failure management, a full recovery often occurs within weeks. Long-term impairment is rare, with neurological impairment occurring most frequently. Despite an abundance of research on the persistent neurological and hepatic impairments, our knowledge of the long-term cardiovascular events in patients with heatstroke history is poor. We wondered whether heatstroke leads to cardiovascular diseases long after full recovery. Using Pubmed, Web of Science and Scopus, we gathered cohort studies looking at cardiovascular disease incidence or mortality as an outcome, including heatstroke animal studies. Based on the available literature, we found that a history of heatstroke is associated with an increased risk of cardiovascular diseases, including ischemic heart disease, heart failure and atrial fibrillation. Delayed metabolic disturbances occurring in exertional heatstroke mice are linked to the formation of atherosclerosis and the development of heart failure. These processes provide potential pathophysiological pathways leading to ischemic heart disease and heart failure in heatstroke patients. Our findings may massively impact our understanding of heatstroke recovery and the follow up of heatstroke patients. Therefore larger, more adequately powered cohort studies with cardiovascular disease as an outcome, in tandem with animal studies examining the underlying pathophysiology, are required to confirm or reject these findings and answer the proposed questions.

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Challenging Return to Play Decisions

Cited by 34 publications

References 46 publications

Biochemical recovery from exertional heat stroke follows a 16-day time course

Biochemical recovery from exertional heat stroke follows a 16-day time course

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Long-Term Cardiovascular Diseases of Heatstroke: A Delayed Pathophysiology Outcome

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