Does gender affect rectal temperature cooling rates? A critically appraised topic

Abstract

Clinical Scenario: Exertional heat stroke (EHS) is a medical emergency characterized by body core temperatures > 40.5°C and central nervous system dysfunction. An EHS diagnosis should be immediately followed by cold-water immersion (CWI). Ideally, EHS victims cool at a rate > 0.15°C/min until their temperature reaches 38.9°C. While generally accepted, these EHS treatment recommendations often stem from research that examined only males. Since gender differences exist in anthropomorphics (eg, body surface area, lean body mass) and anthropomorphics impact CWI cooling rates, it is possible that CWI cooling rates may differ between genders. Clinical Question: Do CWI rectal temperature (Trec) cooling rates differ between hyperthermic males and females? Summary of Findings: The average Trec cooling rate across all examined studies for males and females was 0.18 (0.05) and 0.24 (0.03)°C/min, respectively. Hyperthermic females cooled ~33% faster than males. Clinical Bottom Line: Hyperthermic females cooled faster than males, most likely because of higher body surface area to mass ratios and less lean body mass. Regardless of gender, CWI is highly effective at lowering Trec. Clinicians must be able to treat all EHS victims, regardless of gender, with CWI, given its high survival rate when implemented appropriately. Strength of Recommendation: Moderate evidence (2 level 3 studies) suggests that females cool faster than males when treated with CWI following severe hyperthermia. Despite gender differences, cooling rates exceeded cooling rate recommendations for EHS victims (ie, 0.15°C/min).