Heat Stroke in the Prehospital Setting: Clinical Characteristics, Management, and Factors Associated with Mortality in Central-Eastern Tunisia

• Imen KETATA

  AHU urgence Ibn Jazzar Kairouan

• Haifa Bradai

• Rabeb Mbaek

• Imen Mabrouk

• Chafiaa Bouhamed

• Naoufel chebili

 Background :

 Heat stroke is a life-threatening medical emergency characterized by a rapid elevation of core body temperature (>40 °C) associated with neurological and cardiovascular disturbances, potentially leading to multiple organ dysfunction syndrome.

Objective To describe the clinical, therapeutic, and prognostic characteristics of heat stroke in the prehospital setting and to identify factors associated with mortality.

Methods : A descriptive cross-sectional study was conducted by SAMU 03 in central-eastern Tunisia (Mahdia, Monastir, Sousse, and Kairouan) over a three-month period (June–August 2023). Twenty-seven adult patients presenting with non-exertional heat stroke were included. Data were collected using a standardized form and analyzed using SPSS version 25.0. Descriptive and univariate analyses were performed to identify factors associated with mortality.

Results : The mean age was 75 ± 17.5 years, with a female predominance (55.6%). Most patients had comorbidities (85.2%). Hyperthermia and neurological impairment were constant findings; 51.9% of patients were comatose. Multiorgan involvement included acute kidney injury (33.3%), rhabdomyolysis (14.8%), metabolic acidosis (14.8%), and coagulation disorders (18.5%). Prehospital management included physical cooling (92.6%), pharmacological cooling (70.3%), oral hydration (48.1%), intravenous fluid resuscitation (85.1%), oxygen therapy (48.1%), and mechanical ventilation (22.2%). Mortality was 33.3%. Univariate analysis identified the following predictors of mortality: core temperature, confusion, coma, visceral involvement, hemodynamic instability, acute kidney injury, metabolic acidosis, coagulation disorders, rhabdomyolysis, use of mechanical ventilation, vasoactive drugs, and oral hydration. The type of cooling method was not significantly associated with outcome.

Conclusion : Heat stroke remains a severe condition with high mortality. Early identification of high-risk patients and prompt prehospital intervention are essential to improve outcomes. Despite rapid management, multiorgan failure remains a major contributor to mortality, highlighting the need for further studies to optimize therapeutic strategies.

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