RISK FACTORS FOR HEAT RELATED DEATHS DURING THE JUNE 2015 HEAT WAVE IN KARACHI, PAKISTAN

Authors

  • Syed Ghazanfar Saleem Emergency Department, The Indus Hospital
  • Tehreem Ansari
  • Ashraf Shamshad Ali
  • Sara Fatima
  • Mariam Hassan Rizvi
  • Muhammad Abdul Samad

Abstract

Background: Mortality as a consequence of heat related illness is a public health concern. Emergency department (ED) experiences increased patients’ flow and decreased survival as a consequence of heat stroke during the episodes of heat wave. The present study was conducted to identify the risk factors for mortality among victims of heat wave (17th – 23rd June), 2015 evaluated in the Emergency Department of The Indus Hospital (TIH), Karachi. Methods: In this cross-sectional study data was retrospectively collected. Out of 2278 patients, 150 patients who satisfied the inclusion criteria (core body temperature >38 °C, dehydrated and CNS dysfunction without infection) were included. Data was analysed using SPSS version 21 (IBM). Results: Among 150 patients included for analysis, the mortality was observed in twenty-four patients (16%). Majority (64.7%) of the patients included in this retrospective study were males and older with median age of 51.5 years. It was identified that non-survivors had significantly lower diastolic blood pressure and oxygen saturation compared to survivors along with higher median reparatory rate, pulse rate, temperature, and length of stay in emergency, shock index, and proportion of unconscious level. Conclusion: The study concluded that heat stroke patients with decreased diastolic blood pressure and oxygen saturation as well as patients with increased shock index, low conscious level and higher core temperature, respiratory and pulse rate should be considered for more intensive management in Intensive Care Unit (ICU) to decrease mortality rate during future heat stroke episodes.Keywords: Emergency department; heat stroke; heat wave; hyperthermia; mortality; Pakistan; Karachi

Author Biography

Syed Ghazanfar Saleem, Emergency Department, The Indus Hospital

Consultant, Emergency Department, The Indus Hospital

References

Whitman S, Good G, Donoghue ER, Benbow N, Shou W, Mou S. Mortality in Chicago attributed to the July 1995 heat wave. Am J Public Health 1997;87(9):1515–8.

Naughton MP, Henderson A, Mirabelli MC, Kaiser R, Wilhelm JL, Kieszak SM, et al. Heat-related mortality during a 1999 heat wave in Chicago. Am J Prev Med 2002;22(4):221–7.

Vandentorren S, Suzan F, Medina S, Pascal M, Maulpoix A, Cohen JC, et al. Mortality in 13 French cities during the August 2003 heat wave. Am J Public Health 2004;94(9):1518–20.

Pirard P, Vandentorren S, Pascal M, Laaidi K, Le Tertre A, Cassadou S, et al. Summary of the mortality impact assessment of the 2003 heat wave in France. Euro Surveill 2005;10(7):153–6.

Conti S, Meli P, Minelli G, Solimini R, Toccaceli V, Vichi M, et al. Epidemiologic study of mortality during the Summer 2003 heat wave in Italy. Environ Res 2005;98(3):390–9.

Fouillet A, Rey G, Wagner V, Laaidi K, Empereur-Bissonnet P, Le Tertre A, et al. Has the impact of heat waves on mortality changed in France since the European heat wave of summer 2003? A study of the 2006 heat wave. Int J Epidemiol 2008;37(2):309–17.

Tan J, Zheng Y, Song G, Kalkstein LS, Kalkstein AJ, Tang X. Heat wave impacts on mortality in Shanghai, 1998 and 2003. Int J Biometeorol 2007;51(3):193–200.

Huang W, Kan H, Kovats S. The impact of the 2003 heat wave on mortality in Shanghai, China. Sci Total Environ 2010;408(11):2418–20.

Ghumman U, Horney J. Characterizing the Impact of Extreme Heat on Mortality, Karachi, Pakistan, June 2015. Prehosp Disaster Med 2016;31(3):263–6.

Berger T, Green J, Horeczko T, Hagar Y, Garg N, Suarez A, et al. Shock index and early recognition of sepsis in the Emergency Department: Pilot study. West J Emerg Med 2013;14(2):168–74.

Chaudhry QZ, Rasul G, Kamal A, Ahmad M, Mahmood S. Government of Pakistan Ministry of Climate Change. Technical Report on Karachi Heat wave June 2015. [Internet]. [cited 2016 Mar 23]. Available from: http://www.ndma.gov.pk/files/heatwave.pdf

Davido A, Patzak A, Dart T, Sadier MP, Meraud P, Masmoudi R, et al. Risk factors for heat related death during the August 2003 heat wave in Paris, France, in patients evaluated at the emergency department of the Hôpital Européen Georges Pompidou. Emerg Med J 2006;23(7):515–8.

Basu R, Samet JM. Relation between elevated ambient temperature and mortality: A review of the epidemiologic evidence. Epidemiol Rev 2002;24(2):190–202.

Hart GR, Anderson RJ, Crumpler CP, Shulkin A, Reed G, Knochel JP. Epidemic classical heat stroke: Clinical characteristics and course of 28 patients. Medicine (Baltimore) 1982;61(3):189–97.

Vicario SJ, Okabajue R, Haltom T. Rapid cooling in classic heatstroke: Effect on mortality rates. Am J Emerg Med 1986;4(5):394–8.

Rady MY, Smithline HA, Blake H, Nowak R, Rivers E. A Comparison of the Shock Index and Conventional Vital Signs to Identify Acute, Critical Illness in the Emergency Department. Ann Emerg Med 1994;24(4):685–90.

Faunt JD, Wilkinson TJ, Aplin P, Henschke P, Webb M, Penhall RK. The effete in the heat: Heat-related hospital presentations during a ten day heat wave. Aust N Z J Med 1995;25(2):117–21.

Downloads

Published

2017-04-08