Exertional heat stroke (EHS)

Exertional heat stroke (EHS) is a life-threatening condition that can occur during physical activity in high temperatures. It is essential to diagnose EHS early and treat it promptly to prevent serious complications such as multi-organ failure and death. However, there are several controversies in the diagnosis of EHS, which can lead to delayed diagnosis and treatment.

One of the main controversies in EHS diagnosis is the core body temperature threshold. The American College of Sports Medicine (ACSM) recommends a core body temperature of 40.5°C (105°F) or higher for the diagnosis of EHS. However, some studies suggest that a lower temperature threshold of 40°C (104°F) may be more appropriate, as some individuals may develop EHS at lower temperatures. Moreover, recent research has highlighted the limitations of relying solely on core body temperature to diagnose EHS, as some athletes may develop EHS despite having a normal core body temperature.

Another controversial aspect of EHS diagnosis is the role of other clinical signs and symptoms. The ACSM recommends that a diagnosis of EHS should be based on a combination of high core body temperature, central nervous system dysfunction, and systemic inflammatory response. However, some studies suggest that relying solely on these criteria may miss cases of EHS, as some athletes may not present with all of these symptoms. For example, some individuals may only exhibit gastrointestinal symptoms or muscle cramps, which may not be immediately recognized as signs of EHS.

The timing of EHS diagnosis is another controversial issue. In some cases, athletes may continue to exercise despite exhibiting early signs of EHS, such as fatigue, headache, or dizziness. In these cases, delaying the diagnosis of EHS until core body temperature reaches the threshold of 40.5°C may be too late, as the individual may already be experiencing significant organ damage. Therefore, some experts recommend that EHS diagnosis should be made based on a combination of clinical signs and symptoms, rather than relying solely on core body temperature.

Finally, there is some debate about the use of invasive monitoring techniques, such as rectal temperature measurement, in the diagnosis of EHS. While these techniques provide accurate measurements of core body temperature, they may be uncomfortable or embarrassing for athletes, which could discourage them from reporting early symptoms of EHS. Therefore, some experts recommend the use of non-invasive temperature measurement methods, such as infrared thermometers, to encourage early reporting and improve the accuracy of EHS diagnosis.

In conclusion, the diagnosis of EHS remains a complex and controversial issue. While the ACSM provides guidelines for the diagnosis of EHS based on core body temperature, central nervous system dysfunction, and systemic inflammatory response, there are several limitations to this approach. Future research should focus on developing more sensitive and specific diagnostic criteria for EHS that take into account a broader range of clinical signs and symptoms, as well as the individual variability in temperature responses.


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