Influence of the coronavirus disease 2019 (COVID‐19) pandemic on the incidence of heat stroke and heat exhaustion in Japan: a nationwide observational study based on the HeatstrokeSTUDY2019 (withoutCOVID‐19) and 2020 (withCOVID‐19)

Abstract

Aim To assess heat stroke and heat exhaustion occurrence and response during the coronavirus disease 2019 pandemic in Japan. Methods This retrospective, multicenter, registry‐based study describes and compares the characteristics of patients between the months of July and September in 2019 and 2020. Factors affecting heat stroke and heat exhaustion were statistically analyzed. Cramér’s V was calculated to determine the effect size for group comparisons. We also investigated the prevalence of mask wearing and details of different cooling methods. Results No significant differences were observed between 2019 and 2020. In both years, in‐hospital mortality rates just exceeded 8%. Individuals >65 years old comprised 50% of cases and non‐exertional onset (office work and everyday life) comprised 60%–70%, respectively. The recommendations from the Working Group on Heat Stroke Medicine given during the coronavirus disease pandemic in 2019 had a significant impact on the choice of cooling methods. The percentage of cases, for which intravascular temperature management was performed and cooling blankets were used increased, whereas the percentage of cases in which evaporative plus convective cooling was performed decreased. A total of 49 cases of heat stroke in mask wearing were reported. Conclusion Epidemiological assessments of heat stroke and heat exhaustion did not reveal significant changes between 2019 and 2020. The findings suggest that awareness campaigns regarding heat stroke prevention among the elderly in daily life should be continued in the coronavirus disease 2019 pandemic. In the future, it is also necessary to validate the recommendations of the Working Group on Heatstroke Medicine.

A prehospital risk assessment tool predicts clinical outcomes in hospitalized patients with heat-related illness: a Japanese nationwide prospective observational study

“…The early risk assessment tool for detecting clinical outcomes in patients with heat-related illness, called the J-ERATO score, was defined as the sum of six binary components in the prehospital setting (respiratory rate ≥ 22 /min, Glasgow Coma Scale score < 15, systolic blood pressure ≤ 100 mmHg, heart rate ≥ 100 bpm, body temperature ≥ 38 °C, and age ≥ 65 years), with a total score ranging from 0 to 6 (Supplemental Table 1 ). We demonstrated that the J-ERATO score is accurate in predicting ICU admission and in-hospital mortality 11 , 12 . Furthermore, the usefulness of the J-ERATO score has been successfully validated in South India, which has a population with a different age distribution to Japan 13 .…”

“…Since 2017, this registry has been used to gather information regarding only patients admitted to the hospital owing to a diagnosis of heat-related illness. Approximately 142 emergency hospitals from all over Japan took part in the registry during the study period 12 . Data were manually recorded by the staff at each participating hospital by using standardized record sheets.…”

Sequential organ failure assessment score as a predictor of the outcomes of patients hospitalized for classical or exertional heatstroke

“…In the present study, we performed retrospective analyses of data from the JAAM heatstroke registry, a nationwide multicenter observational registry collated annually since 2014 by the JAAM 11 . In 2019 (1 July–30 September), 148 hospitals participated in data collection (see acknowledgements).…”

Heat stroke management during the COVID‐19 pandemic: Recommendations from the experts in Japan (2nd edition)

“…According to the Japanese Association for Acute Medicine Heatstroke STUDY, 62.6% of the cases in 2019 were treated with extracellular fluid infusion without active cooling, whereas 70.0% of the cases in 2020 were treated in this manner. Furthermore, the percentage of active cooling methods that used evaporative plus convective cooling was 77.9% in 2019, but this decreased to 61.6% in 2020 54 .…”