Evidence-Based Heatstroke Management in the Emergency Department.

INTRODUCTION: Climate change is causing an increase in the frequency and intensity of extreme heat events, which disproportionately impact the health of vulnerable populations. Heatstroke, the most serious heat-related illness, is a medical emergency that causes multiorgan failure and death without intervention. Rapid recognition and aggressive early treatment are essential to reduce morbidity and mortality. The objective of this study was to evaluate current standards of care for the emergent management of heatstroke and propose an evidence-based algorithm to expedite care. METHODS: We systematically searched PubMed, Embase, and key journals, and reviewed bibliographies. Original research articles, including case studies, were selected if they specifically addressed the recognition and management of heatstroke in any prehospital, emergency department (ED), or intensive care unit population. Reviewers evaluated study quality and abstracted information regarding demographics, scenario, management, and outcome. RESULTS: In total, 63 articles met full inclusion criteria after full-text review and were included for analysis. Three key themes identified during the qualitative review process included recognition, rapid cooling, and supportive care. Rapid recognition and expedited external or internal cooling methods coupled with multidisciplinary management were associated with improved outcomes. Delays in care are associated with adverse outcomes. We found no current scalable ED alert process to expedite early goal-directed therapies. CONCLUSION: Given the increased risk of exposure to heat waves and the time-sensitivity of the condition, EDs and healthcare systems should adopt processes for rapid recognition and management of heatstroke. This study proposes an evidence-based prehospital and ED heat alert pathway to improve early diagnosis and resource mobilization. We also provide an evidence-based treatment pathway to facilitate efficient patient cooling. It is hoped that this protocol will improve care and help healthcare systems adapt to changing environmental conditions.

Neuroanatomical correlates of sensory deficits in children with neonatal arterial ischemic stroke.

AIM: Our aim was to characterize the sensory processing outcome following neonatal arterial ischemic stroke (NAIS) and identify neuroanatomical correlates of abnormal sensory processing. METHOD: We evaluated children with NAIS longitudinally at 12 months, 18 months, and/or 30 months in areas of cognitive, motor, and language development. We gathered sensory processing data using the Sensory Profile-2 Caregiver Questionnaire. These data were analyzed against early magnetic resonance imaging using a voxel-based approach. RESULTS: Eighteen children (10 males, 8 females) with NAIS were evaluated longitudinally, of which six exhibited atypical sensory processing. Children with sensory processing deficits had lower overall developmental scores in motor, cognitive, and language domains. Neuroanatomical correlates were identified in the posterior periventricular white matter extending superiorly into the supramarginal gyrus, and inferiorly into the fusiform and inferior temporal gyri. INTERPRETATION: Our results provide new evidence that children with NAIS may experience difficulty processing sensory information, which is most likely associated with injuries in the posterior periventricular white matter, supramarginal gyrus, fusiform gyrus, and posterior thalamic radiation. WHAT THIS PAPER ADDS: Atypical sensory processing is common in children with neonatal arterial ischemic stroke (NAIS). NAIS territories in sensory areas were correlated with atypical sensory processing behaviors. Children with NAIS may benefit from early interventions targeted toward sensory processing. Future research mapping NAIS injuries using early magnetic resonance imaging may predict long-term outcomes.

CORRELACIÓN NEUROANATÓMICA DE LOS DÉFICITS SENSORIALES EN NIÑOS CON INFARTO ISQUÉMICO ARTERIAL NEONATAL: OBJETIVO: Nuestro objetivo fue caracterizar los efectos el procesamiento sensorial posterior a un ictus isquémico arterial neonatal (IIAN) e identificar la relación neuroanatómica del procesamiento sensorial anormal. MÉTODO: Evaluamos longitudinalmente a niños con IIAN a los 12, 18 y/o 30 meses en áreas de desarrollo cognitivo, motor y lingüístico. Recopilamos los datos del procesamiento sensorial usando el Perfil Sensorial. Estos datos fueron analizados contra las imágenes de resonancia magnética temprana utilizando la técnica de voxel-based morphometry. RESULTADOS: Fueron evaluados longitudinalmente 18 niños (10 varones, 8 mujeres) con IIAN, de los cuales seis mostraron un procesamiento sensorial atípico. Los niños con déficit del procesamiento sensorial tuvieron puntuaciones menores del desarrollo general en los dominios motor, cognitivo y lingüístico. La correlación neuroanatómica fue identificada en la sustancia blanca periventricular posterior extendiéndose superiormente hacia el giro supramarginal e inferiormente dentro del giro fusiforme y el giro temporal inferior. INTERPRETACIÓN: Nuestros resultados proporcionan nuevas evidencias que los niños con IIAN pueden experimentar dificultades en el procesamiento de información sensorial, que está probablemente asociado con lesiones en la sustancia blanca periventricular posterior, giro supramarginal, giro fusiforme y la radiación talámica posterior.

CORRELATOS NEUROANATÔMICOS DOS DÉFICITS SENSORIAIS EM CRIANÇAS COM ACIDENTE VASCULAR CEREBRAL ISQUÊMICO NEONATAL: OBJETIVOS: Nosso objetivo foi avaliar os resultados de processamento sensorial após acidente vascular cerebral isquêmico neonatal (AVC-IN) e identificar correlatos neuroanatômicos de processamentos sensoriais anormais. MÉTODO: Foram avaliadas crianças com AVC-IN longitudinalmente com 12 meses, 18 meses, e /ou 30 meses nas áreas do desenvolvimento cognitivo, motor e linguagem. Obtivemos os dados do processamento sensorial utilizando o Perfil Sensorial. Os dados foram analisados através de imagens de ressonância magnética precoce utilizando uma abordagem baseada em Voxel. RESULTADOS: Dezoito crianças (10 meninos e 8 meninas) com AVC-IN foram avaliadas longitudinalmente, das quais seis exibiram processamento sensorial atípico. Crianças com déficits de processamento sensorial tiveram menor pontuação total nos domínios de desempenho motor, cognitivo, e de linguagem. Correlatos neuroanatômicos foram identificados na substancia branca periventricular posterior, estendendo-se superiormente até o giro supramarginal e inferiormente até o giro fusiforme, e giro temporal inferior. INTERPRETAÇÃO: Estes resultados proporcionam novas evidencias de que crianças com AVC-I possam apresentar dificuldades de processar informações sensoriais, o que está provavelmente associado com danos ocorridos na substancia branca periventricular posterior, giro supramarginal, giro fusiforme, e projeções talâmicas posteriores.