Department of Emergency Medicine, Boston University School of Medicine, Boston, MA.
Med Sci Sports Exerc. 2021 Sep 1;53(9):1818-1825. doi: 10.1249/MSS.0000000000002652.
This study aimed to assess associations between exertional heat stroke (EHS) and sex, age, prior performance, and environmental conditions, and report on resources needed for EHS cases at the Boston Marathon.
We analyzed participant characteristics, environmental data, and EHS medical encounters during the 2015-2019 Boston Marathon races.
Among 136,161 starters, there was an incidence of 3.7 EHS cases per 10,000 starters (95% confidence interval, 2.8-4.9), representing 0.5% of all medical encounters. There were significant associations between sex and age (P < 0.0001), sex and start wave (P < 0.0001), and age group and start wave (P < 0.0001). Sex was not significantly associated with increased EHS incidence; however, age younger than 30 yr and assignment to the first two start waves were. All cases occurred at races with average wet bulb globe temperatures of 17°C-20°C. There was a linear correlation between EHS incidence and greater increases in wet bulb globe temperature from start to peak (R2 = 0.7688). A majority of cases (37; 72.5%) were race finishers; nonfinishers all presented after mile 18. Most were triaged 3-4 h after starting, and all were treated with ice water immersion. Treatment times were prolonged (mean (SD), 78.1 (47.5) min; range, 15-190 min); 29.4% (15 cases) developed posttreatment hypothermia, and 35.3% (18 cases) were given intravenous fluids. Most (31 cases; 64.6%) were discharged directly, although 16 cases (33.3%) required hospital transport. There were no fatalities.
Younger and faster runners are at higher risk for EHS at the Boston Marathon. Greater increases in heat stress from start to peak during a marathon may exacerbate risk. EHS encounters comprise a small percentage of race-day medical encounters but require extensive resources and warrant risk mitigation efforts.
本研究旨在评估与运动性热射病（EHS）相关的因素，包括性别、年龄、既往表现和环境条件，并报告波士顿马拉松比赛中 EHS 病例所需的资源。
我们分析了 2015 年至 2019 年波士顿马拉松比赛中参赛选手的特征、环境数据和 EHS 医疗情况。
在 136161 名参赛者中，每 10000 名参赛者中有 3.7 例 EHS（95%置信区间，2.8-4.9），占所有医疗情况的 0.5%。性别和年龄（P < 0.0001）、性别和出发波次（P < 0.0001）以及年龄组和出发波次（P < 0.0001）之间存在显著相关性。性别与 EHS 发病率增加无关，但年龄小于 30 岁且被分配到前两个出发波次的发病率增加。所有病例均发生在平均湿球黑球温度为 17°C-20°C 的比赛中。EHS 发病率与从出发到峰值时湿球黑球温度的升高呈线性相关（R2 = 0.7688）。大多数病例（37 例；72.5%）是比赛完赛者；未完赛者均在 18 英里后出现。大多数在开始后 3-4 小时进行分诊，均接受冰水浸泡治疗。治疗时间延长（平均值（SD），78.1（47.5）分钟；范围，15-190 分钟）；29.4%（15 例）出现治疗后低体温，35.3%（18 例）给予静脉输液。大多数（31 例；64.6%）直接出院，尽管 16 例（33.3%）需要医院转运。无死亡病例。
在波士顿马拉松比赛中，年龄较小和速度较快的跑步者发生 EHS 的风险更高。马拉松比赛中从出发到峰值时的热应激增加可能会使风险加剧。EHS 情况在比赛日的医疗情况中占比较小，但需要大量资源，因此需要进行风险缓解工作。
