Exertional Heatstroke Survivors’ Knowledge and Beliefs About Exertional Heatstroke Diagnosis, Treatment, and Return to Play

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CONTEXT: Little information exists regarding what exertional heatstroke (EHS) survivors know and believe about EHS best practices. Understanding this would help clinicians focus educational efforts to ensure survival and safe return-to-play following EHS. OBJECTIVE: We sought to better understand what EHS survivors knew about EHS seriousness (eg, lethality and short- and long-term effects), diagnosis and treatment procedures, and recovery. DESIGN: Multiyear cross-sectional descriptive design. SETTING: An 11.3-km road race located in the Northeastern United States in August 2022 and 2023. PATIENTS OR OTHER PARTICIPANTS: Forty-two of 62 runners with EHS (15 women and 27 men; age = 33 ± 15 years; pretreatment rectal temperature [TREC] = 41.5°C ± 0.9°C). INTERVENTIONS: Medical professionals evaluated runners requiring medical attention at the finish line. If they observed a TREC of ≥40°C with concomitant central nervous system dysfunction, EHS was diagnosed, and patients were immersed in a 189.3-L tub filled with ice water. Before medical discharge, we asked EHS survivors 15 questions about their experience and knowledge of select EHS best practices. Survey items were piloted and validated by experts and laypersons a priori (content validity index of ≥0.88 for items and scale). MAIN OUTCOME MEASURES: Survey responses. RESULTS: Sixty-seven percent (28/42) of patients identified EHS as potentially fatal, and 76% (32/42) indicated that it negatively affected health. Seventy-nine percent (33/42) correctly identified TREC as the best temperature site to diagnose EHS. Most patients (74%, 31/42) anticipated returning to normal exercise within 1 week after EHS; 69% (29/42) stated that EHS would not impact future race participation. Patients (69%, 29/42) indicated that it was important to tell their primary care physician about their EHS. CONCLUSIONS: Our patients were knowledgeable on the potential seriousness and adverse health effects of EHS and the necessity of TREC for diagnosis. However, educational efforts should be directed toward helping patients understand safe recovery and return-to-play timelines following EHS.

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