Probability of Heat Intolerance: Standardized Interpretation of Heat-Tolerance Testing Results Versus Specialist Judgment

Schermann, Haggai; Craig, Erin; Yanovich, Einat; Ketko, Itay; Kalmanovich, Gary; Yanovich, Ran

doi:10.4085/1062-6050-519-16

Cited by 23 publications

(34 citation statements)

References 15 publications

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“…The Israeli Defense Force employs a 120-min HTT consisting of walking at 5 km/h on a treadmill set at a 2% grade in 40°C and 40% relative humidity. The protocol is halted if the rectal temperature reaches 39°C, the HR reaches 180 beats/ min, or if the participant becomes symptomatic with dizziness or fainting (53,71,72). This test is usually performed 6 -8 wk after the heat stroke episode.…”

Section: Endotoxemia Mediates Ehsmentioning

confidence: 99%

Controversies in exertional heat stroke diagnosis, prevention, and treatment

Laitano

Leon

Roberts

et al. 2019

Journal of Applied Physiology

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During the past several decades, the incidence of exertional heat stroke (EHS) has increased dramatically. Despite an improved understanding of this syndrome, numerous controversies still exist within the scientific and health professions regarding diagnosis, pathophysiology, risk factors, treatment, and return to physical activity. This review examines the following eight controversies: 1) reliance on core temperature for diagnosing and assessing severity of EHS; 2) hypothalamic damage induces heat stroke and this mediates “thermoregulatory failure” during the immediate recovery period; 3) EHS is a predictable condition primarily resulting from overwhelming heat stress; 4) heat-induced endotoxemia mediates systemic inflammatory response syndrome in all EHS cases; 5) nonsteroidal anti-inflammatory drugs for EHS prevention; 6) EHS shares similar mechanisms with malignant hyperthermia; 7) cooling to a specific body core temperature during treatment for EHS; and 8) return to physical activity based on physiological responses to a single-exercise heat tolerance test. In this review, we present and discuss the origins and the evidence for each controversy and propose next steps to resolve the misconception.

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Section: Endotoxemia Mediates Ehsmentioning

confidence: 99%

Controversies in exertional heat stroke diagnosis, prevention, and treatment

Laitano

Leon

Roberts

et al. 2019

Journal of Applied Physiology

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“…Because previous studies on the association between heat exposure and HS were primarily restricted to small geographical regions, an epidemiological study of HS at the national and international levels was essential [ 5 ]. Hence, in the neighboring subtropical Sahara and Arabian deserts, the Israel Defense Forces used a heat-tolerance test (HTT) as a screening tool for the secondary prevention of exertional heat illness [ 14 ]. In addition, during the Hadj season in Mecca, Saudi-Arabia, HS threatens the health of pilgrims [ 15 ], thus specific climatic and social customs have led these countries to invest in HS research.…”

Section: Discussionmentioning

confidence: 99%

Research progress of heat stroke during 1989–2019: a bibliometric analysis

Xia

Wang²,

Zhou

et al. 2021

Military Med Res

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Background Heat stroke (HS) is an acute physical disorder that is associated with a high risk of organ dysfunction and even death. HS patients are usually treated symptomatically and conservatively; however, there remains a lack of specific and effective drugs in clinical practice. An analysis of publication contributions from institutions, journals and authors in different countries/regions was used to study research progress and trends regarding HS. Methods We extracted all relevant publications on HS between 1989 and 2019 from Web of Science. Using the Statistical Package for Social Science (SPSS, version 24) and the software GraphPad Prism 8, graphs were generated and statistical analyses were performed, while VOSviewer software was employed to visualize the research trends in HS from the perspectives of co-occurring keywords. Results As of April 14, 2020, we identified 1443 publications with a citation frequency of 5216. The United States accounted for the largest number of publications (36.2%) and the highest number of citations (14,410), as well as the highest H-index at 74. Although the sum of publications from China ranked second, there was a contradiction between the quantity and quality of publications. Furthermore, Medicine & Science in Sports & Exercise published the most papers related to HS, with Lin MT publishing the most papers in this field (112), while the review by Knochel JP received the highest citation frequency at 969. The keyword heat-stress appeared most recently, with an average appearing year of 2015.5. In the clinical research cluster, exertional heat-stroke was determined to be the hotspot, while ambient-temperature and heat waves were the new trends in the epidemiological research cluster. Conclusions Corresponding to this important field, while the contributions of the publications from the United States were significant, the mismatch between the quantity and quality of publications from China must be examined. Moreover, it is hypothesized that clinical and epidemiological studies may become hotspots in the near future.

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“…The HTT was performed according to the protocol described previously. 5 Records of all participants were reviewed for information regarding the EHI event date, testing date and result, participant baseline characteristics (age, height, and weight), and EHI event characteristics (type of activity during which the event occurred, cooling delay [immediate cooling versus cooling delayed beyond 30 minutes after the development of the signs of EHI], rectal temperature measurement, neurologic symptoms on presentation, and laboratory abnormalities). The participants were subsequently classified as having EHS based on a rectal temperature of 408C or higher within 10 minutes of presentation.…”

Section: Methodsmentioning

confidence: 99%

“…This requirement was a major disadvantage, which has recently been addressed by applying computational methods for the objective interpretation of results. 5 The original HTT protocol, which was based on early observations, was an exercise heat-stress exposure scheduled 6 to 8 weeks after the clinical recovery from the EHI. This relatively long period of recovery was suggested because of the concern that earlier testing might be associated with positive results (HI) in participants who had sustained an EHS.…”

mentioning

confidence: 99%

When Should a Heat-Tolerance Test Be Scheduled After Clinical Recovery From an Exertional Heat Illness?

Schermann

Hazut-Krauthammer

Weksler

et al. 2020

Journal of Athletic Training

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Objective Researchers have produced a hypothesis of transient heat intolerance (HI) after exertional heat stroke (EHS). Based on this hypothesis, heat-tolerance testing (HTT) has been postponed until weeks 6 to 8 after EHS and other types of exertional heat illness (EHI). We compared the HTT results of participants after either EHS or other EHI who were tested earlier (≤6-week group) versus those who were tested later (>6-week group) to verify the hypothesis. Design Cohort study. Setting Data obtained from records of military athletes who experienced EHS or EHI. Patients or Other Participants All participants who underwent HTT after EHI or EHS experienced between 2014 and 2018 and for whom complete data regarding the severity of the event (rectal temperature, neurologic symptoms, and laboratory results) and HTT results were available were included. Participants with suspected EHS and those with other EHIs were evaluated separately. Main Outcome Measure(s) The percentages of participants with HI and mean probability of heat tolerance were compared between those tested within 6 weeks of the event and those tested later. Results A total of 186 participants were included in this study (EHS: 12 in the <6-week group, 9 in the >6-week group; EHI: 94 in the <6-week group, 71 in the >6-week group). In the EHS group, the percentages with HI (33% versus 44%, P = .67) and mean probability of heat tolerance (0.82 versus 0.82, P = .98) did not differ. In the EHI group, participants who were tested after 6 weeks had a greater chance of being diagnosed with HI (38% versus 21.3%, P < .02) Conclusions The HTT results were similar between participants with EHS who were tested early (<6 weeks) and those tested late (>6 weeks). Further investigation of heat-tolerance changes in larger cohorts of patients after EHS is required to verify the theory of transient HI.

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Probability of Heat Intolerance: Standardized Interpretation of Heat-Tolerance Testing Results Versus Specialist Judgment

Abstract: The PHT has the potential to be substituted for manual interpretation of the HTT and to serve in a variety of clinical and research applications.

Cited by 23 publications

References 15 publications

Controversies in exertional heat stroke diagnosis, prevention, and treatment

Controversies in exertional heat stroke diagnosis, prevention, and treatment

Research progress of heat stroke during 1989–2019: a bibliometric analysis

When Should a Heat-Tolerance Test Be Scheduled After Clinical Recovery From an Exertional Heat Illness?

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