Comparison between the bouchama and japanese association for acute medicine heatstroke criteria with regard to the diagnosis and prediction of mortality of heatstroke patients: A multicenter observational study

Abstract

Background: This study aims to compare the Bouchama heatstroke (B-HS) and Japanese Association for Acute Medicine heatstroke (JAAM-HS) criteria with regard to the diagnosis and prediction of mortality and neurological status of heatstroke patients. Methods: This multicenter observational study recruited eligible patients from the emergency departments of 110 major hospitals in Japan from 1 July to 30 September, 2014. Results: A total of 317 patients (median age, 65 years; interquartile range, 39–80 years) were included and divided into the B-HS, JAAM-HS, and non-HS groups, with each group consisting of 97, 302, and 15 patients, respectively. The JAAM-HS (1.0; 95% and confidence low sensitivity interval to [CI], mortality, 0.87–1.0) respectively. and B-HS (0.29; Similarly, 95% CI, the 0.14–0.49) JAAM-HS criteria (1.0; 95% showed CI, 0.93–1.0) high and and low B-HS sensitivity (0.35; 95% to mortality, CI, 0.23–0.49) respectively. criteria showed Similarly, high the and JAAM-HS low sensitivity (1.0; 95% to CI, poor 0.93–1.0) neurological and B-HS status, (0.35; respectively. 95% CI, 0.23–0.49) Meanwhile, criteria the showed sequential high and organ low failure sensitivity assessment to poor neurological (SOFA) scores status, demonstrated respectively. good Meanwhile, accuracy the in sequential predicting organ mortality failure among assessment heat-related (SOFA) illness scores (HRI) demonstrated patients. good However, accuracy both in JAAM-HS predicting and mortality B-HS criteria among could heat-related not predict illness in-hospital (HRI) patients. mortality. However, The AUC both of JAAM-HS the SOFA score and B-HS for mortality criteria could was 0.83 not (day predict 3) among in-hospital the HRI mortality. patients. The The AUC patients’ of the neurological SOFA score status for mortality was difficult was 0.83 to predict (day 3) using among the the JAAM-HS HRI patients. and The B-HS patients’ criteria. neurological Concurrently, status the was total difficult bilirubin to predict level using could the relatively JAAM-HS predict and B-HS the criteria. central Concurrently, nervous system the function total bilirubin at discharge. level could Conclusions: relatively predict The JAAM-HS the central criteria nervous showed system high function sensitivity at discharge. to mortality Conclusions: and could The include JAAM-HS all criteria HRI patients showed who high died. sensitivity The JAAM-HS to mortality criterion and could was include considered all HRI a patients useful tool who for died. judgement The JAAM-HS of admission criterion at was ED. considered Further investigations a useful tool for are judgement necessary of to admission determine at the ED. accuracy Further of investigations both B-HS and are necessary JAAM-HS to criteria determine in predicting the accuracy mortality of both and B-HS neurological and JAAM-HS status criteria at discharge. in predicting mortality and neurological status at discharge. Keywords: heat related illness; heat stroke; emergency; diagnosis.