Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
Emergency Department, Jinhua People's Hospital, Jinhua, 321099, China.
Postgrad Med J. 2023 Nov 20;99(1178):1237-1245. doi: 10.1093/postmj/qgad071.
Transient neuronal dysfunction may occur in most brain regions with heatstroke (HS). This study aimed to explore the prognostic significance of initial Glasgow Coma Scale (GCS) scores in HS.
Retrospective data regarding HS were obtained from six hospitals. The primary outcome was neurological sequelae at discharge. Secondary outcomes included acute respiratory failure (ARF) and intensive care unit (ICU) admission. Logistic regression models and random forest imputation were used to assess the independent association between GCS score and outcomes. Interaction and stratified analyses of body temperature (BT) at 0.5 hours were also conducted. Receiver operating characteristic curves and decision curve analysis were used to estimate prognostic values.
Of 206 patients, 44 (21.36%) had neurological sequelae at discharge. The mean ± standard deviation initial GCS score was 8.17 ± 4.05. After adjustment for confounders, GCS, as a continuous variable, was significantly related to neurological sequelae at discharge [odds ratio (OR): 0.65; 95% confidence interval (CI): 0.50-0.85; P = 0.002], ARF (OR: 0.76; 95% CI: 0.66-0.87; P = 0.001), and ICU admission (OR: 0.68; 95% CI: 0.53-0.87; P = 0.003). These relationships were consistent in the random forest imputation cohort. The OR between GCS and neurological sequelae at discharge was much lower (P = 0.048) in participants with BT at 0.5 hours ≤39°C than in those with BT at 0.5 hours >39°C. The GCS and National Early Warning Score (NEWS) had similar prognostic ability for all outcomes, whereas the net benefits were greater with the GCS compared with the NEWS.
Initial GCS score was an independent prognostic factor for neurological sequelae at discharge in HS. Rapid cooling played a positive role in this relationship. Key messages What is already known on this topic Brain damage caused by heatstroke (HS) can be transient or result in irreversible injury. Early recognition of those at risk of death or developing neurological complications is very important for improving the outcomes of HS. What this study adds Initial Glasgow Coma Scale (GCS) score was an independent prognostic factor for neurological sequelae at discharge, acute respiratory failure, and intensive care unit (ICU) admission in HS. Rapid cooling played a positive role in this relationship. How this study might affect research, practice, or policy The GCS upon emergency department admission can be a useful predictor of prognosis in patients with HS.
中暑（HS）可导致大多数大脑区域出现短暂性神经元功能障碍。本研究旨在探讨初始格拉斯哥昏迷量表（GCS）评分对 HS 的预后意义。
从六家医院获取有关 HS 的回顾性数据。主要结局是出院时的神经后遗症。次要结局包括急性呼吸衰竭（ARF）和重症监护病房（ICU）入住。使用逻辑回归模型和随机森林插补来评估 GCS 评分与结局之间的独立关联。还进行了体温（BT）在 0.5 小时的交互和分层分析。受试者工作特征曲线和决策曲线分析用于评估预后价值。
在 206 名患者中，44 名（21.36%）出院时有神经后遗症。初始 GCS 评分的平均值±标准差为 8.17±4.05。调整混杂因素后，GCS 作为连续变量与出院时的神经后遗症显著相关[比值比（OR）：0.65；95%置信区间（CI）：0.50-0.85；P=0.002]、ARF（OR：0.76；95%CI：0.66-0.87；P=0.001）和 ICU 入住（OR：0.68；95%CI：0.53-0.87；P=0.003）。随机森林插补队列中也存在这种关系。在 BT 在 0.5 小时≤39°C 的参与者中，GCS 与出院时神经后遗症之间的 OR 明显更低（P=0.048），而 BT 在 0.5 小时＞39°C 的参与者中则没有。GCS 和国家早期预警评分（NEWS）对所有结局都有相似的预后能力，而 GCS 的净获益大于 NEWS。
初始 GCS 评分是 HS 出院时神经后遗症的独立预后因素。快速降温在此关系中发挥了积极作用。
