{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:15:29Z","timestamp":1788948929984,"version":"build-2803163510"},"reference-count":35,"publisher":"American Chemical Society (ACS)","issue":"11","license":[{"start":{"date-parts":[[2017,12,29]],"date-time":"2017-12-29T00:00:00Z","timestamp":1514505600000},"content-version":"vor","delay-in-days":1291,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background: Patients with acute heat illness present primarily to emergency departments (EDs), yet little is known regarding these visits.<\/jats:p>\n                  <jats:p>Objective: We aimed to describe acute heat illness visits to U.S. EDs from 2006 through 2010 and identify factors associated with hospital admission or with death in the ED.<\/jats:p>\n                  <jats:p>Methods: We extracted ED case-level data from the Nationwide Emergency Department Sample (NEDS) for 2006\u20132010, defining cases as ED visits from May through September with any heat illness diagnosis (ICD-9-CM 992.0\u2013992.9). We correlated visit rates and temperature anomalies, analyzed demographics and ED disposition, identified risk factors for adverse outcomes, and examined ED case fatality rates (CFR).<\/jats:p>\n                  <jats:p>Results: There were 326,497 (95% CI: 308,372, 344,658) cases, with 287,875 (88.2%) treated and released, 38,392 (11.8%) admitted, and 230 (0.07%) died in the ED. Heat illness diagnoses were first-listed in 68%. 74.7% had heat exhaustion, 5.4% heat stroke. Visit rates were highly correlated with annual temperature anomalies (Pearson correlation coefficient 0.882, p = 0.005). Treat-and-release rates were highest for younger adults (26.2\/100,000\/year), whereas hospitalization and death-in-the-ED rates were highest for older adults (6.7 and 0.03\/100,000\/year, respectively); all rates were highest in rural areas. Heat stroke had an ED CFR of 99.4\/10,000 (95% CI: 78.7, 120.1) visits and was diagnosed in 77.0% of deaths. Adjusted odds of hospital admission or death in the ED were higher among elders, males, urban and low-income residents, and those with chronic conditions.<\/jats:p>\n                  <jats:p>Conclusions: Heat illness presented to the ED frequently, with highest rates in rural areas. Case definitions should include all diagnoses. Visit rates were correlated with temperature anomalies. Heat stroke had a high ED CFR. Males, elders, and the chronically ill were at greatest risk of admission or death in the ED. Chronic disease burden exponentially increased this risk.<\/jats:p>\n                  <jats:p>Citation: Hess JJ, Saha S, Luber G. 2014. Summertime acute heat illness in U.S. emergency departments from 2006 through 2010: analysis of a nationally representative sample. Environ Health Perspect 122:1209\u20131215;\u2002http:\/\/dx.doi.org\/10.1289\/ehp.1306796<\/jats:p>","DOI":"10.1289\/ehp.1306796","type":"journal-article","created":{"date-parts":[[2014,6,17]],"date-time":"2014-06-17T12:59:26Z","timestamp":1403009966000},"page":"1209-1215","source":"Crossref","is-referenced-by-count":124,"title":["Summertime Acute Heat Illness in U.S. Emergency Departments from 2006 through 2010: Analysis of a Nationally Representative Sample"],"prefix":"10.1021","volume":"122","author":[{"given":"Jeremy J.","family":"Hess","sequence":"first","affiliation":[{"name":"Climate and Health Program, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"},{"name":"Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA"},{"name":"Department of Environmental Health, Rollins School of Public Health at Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubhayu","family":"Saha","sequence":"additional","affiliation":[{"name":"Climate and Health Program, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Luber","sequence":"additional","affiliation":[{"name":"Climate and Health Program, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2014,6,17]]},"reference":[{"key":"2026080605024730100_micit1","unstructured":"AHRQ (Agency for Healthcare Research and Quality).\n          \n          2011. Overview of the Nationwide Emergency Department Sample (NEDS): The Nationwide Emergency Department Sample.Available: http:\/\/www.hcup-us.ahrq.gov\/nedsoverview.jsp [accessed 25 July 2012]."},{"key":"2026080605024730100_micit2","unstructured":"AHRQ (Agency for Healthcare Research and Quality).\n          \n          2012. Population Denominator Data for Use with the HCUP Databases (Updated with 2009 Population Data), Report 2010-02.Available: http:\/\/hcup-us.ahrq.gov\/reports\/methods\/2010_02.pdf [accessed 25 July 2012]."},{"key":"2026080605024730100_micit3","unstructured":"AHRQ (Agency for Healthcare Research and Quality).\n          \n          2014. Healthcare Cost and Utilization Project (HCUP).Available: http:\/\/www.ahrq.gov\/research\/data\/hcup\/index.html [accessed 30 September 2014]."},{"issue":"20","key":"2026080605024730100_micit4","doi-asserted-by":"crossref","first-page":"2177","DOI":"10.1001\/archinte.167.20.ioi70147","article-title":"Short- and long-term outcomes of heatstroke following the 2003 heat wave in Lyon, France.","volume":"167","author":"Argaud","year":"2007","journal-title":"Arch Intern Med"},{"issue":"9","key":"2026080605024730100_micit5","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.2105\/AJPH.94.9.1520","article-title":"Municipal heat wave response plans.","volume":"94","author":"Bernard","year":"2004","journal-title":"Am J Public Health"},{"issue":"3","key":"2026080605024730100_micit6","doi-asserted-by":"publisher","first-page":"R54","DOI":"10.1186\/cc5910","article-title":"Cooling and hemodynamic management in heatstroke: practical recommendations.","volume":"11","author":"Bouchama","year":"2007","journal-title":"Crit Care"},{"key":"2026080605024730100_micit7","unstructured":"CDC (Centers for Disease Control and Prevention).\n          \n          2013. International Classification of Diseases, 9th Revision, Clinical Modification.Available: http:\/\/www.cdc.gov\/nchs\/icd\/icd9cm.htm [accessed 12 November 2013]."},{"key":"2026080605024730100_micit8","unstructured":"CDC (Centers for Disease Control and Prevention).\n          \n          2014. NCHS Urban-Rural Classification Scheme for Counties.Available: http:\/\/www.cdc.gov\/nchs\/data_access\/urban_rural.htm [accessed 30 September 2014]."},{"issue":"37","key":"2026080605024730100_micit9","doi-asserted-by":"crossref","first-page":"E2415","DOI":"10.1073\/pnas.1205276109","article-title":"Perception of climate change.","volume":"109","author":"Hansen","year":"2012","journal-title":"Proc Natl Acad Sci USA"},{"key":"2026080605024730100_micit10","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1111\/j.1553-2712.2009.00469.x","article-title":"Climate change and emergency medicine: impacts and opportunities.","volume":"16","author":"Hess","year":"2009","journal-title":"Acad Emerg Med"},{"key":"2026080605024730100_micit11","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/1476-069X-7-5","article-title":"An ecological time-series study of heat-related mortality in three European cities.","volume":"7","author":"Ishigami","year":"2008","journal-title":"Environ Health"},{"key":"2026080605024730100_micit12","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/1472-6947-9-14","article-title":"Syndromic surveillance and heat wave morbidity: a pilot study based on emergency departments in France.","volume":"9","author":"Josseran","year":"2009","journal-title":"BMC Med Inform Decis Mak"},{"issue":"2","key":"2026080605024730100_micit13","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1056\/NEJM199607113350210","article-title":"Killing heat.","volume":"335","author":"Kellermann","year":"1996","journal-title":"N Engl J Med"},{"key":"2026080605024730100_micit14","article-title":"Heat waves and hot environments","author":"Kilbourne E.","year":"1997"},{"key":"2026080605024730100_micit15","article-title":"Disorders of heat regulation","author":"Knochel J, Reed G.","year":"1994"},{"key":"2026080605024730100_micit16","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1289\/ehp.11594","article-title":"The 2006 California heat wave: impacts on hospitalizations and emergency department visits.","volume":"117","author":"Knowlton","year":"2009","journal-title":"Environ Health Perspect"},{"key":"2026080605024730100_micit17","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1146\/annurev.publhealth.29.020907.090843","article-title":"Heat stress and public health: a critical review.","volume":"29","author":"Kovats","year":"2008","journal-title":"Annu Rev Public Health"},{"issue":"11","key":"2026080605024730100_micit18","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1136\/oem.2003.012047","article-title":"Contrasting patterns of mortality and hospital admissions during hot weather and heat waves in Greater London, UK.","volume":"61","author":"Kovats","year":"2004","journal-title":"Occup Environ Med"},{"key":"2026080605024730100_micit19","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.amepre.2008.08.021","article-title":"Climate change and extreme heat events.","volume":"35","author":"Luber","year":"2008","journal-title":"Am J Prev Med"},{"issue":"2","key":"2026080605024730100_micit20","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1007\/s00484-010-0320-6","article-title":"What effect will a few degrees of climate change have on human heat balance? Implications for human activity.","volume":"55","author":"Maloney","year":"2011","journal-title":"Int J Biometeorol"},{"issue":"23","key":"2026080605024730100_micit21","doi-asserted-by":"publisher","first-page":"L23701","DOI":"10.1029\/2009GL040736","article-title":"Relative increase of record high maximum temperatures compared to record low minimum temperatures in the U.S.","volume":"36","author":"Meehl","year":"2009","journal-title":"Geophys Res Lett"},{"key":"2026080605024730100_micit22","unstructured":"Merrill C, Miller M, Steiner C.\n          \n          2008. Hospital Stays Resulting from Excessive Heat and Cold Exposure Due to Weather Conditions in U.S. Community Hospitals, 2005. Rockville, MD:National Center for Biotechnology Information.Available: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK56045\/ [accessed 25 July 2012]."},{"key":"2026080605024730100_micit23","unstructured":"NCDC (National Climatic Data Center).\n          \n          2013. Climate at a Glance.Available: http:\/\/www.ncdc.noaa.gov\/cag\/ [accessed 12 November 2013]."},{"issue":"4","key":"2026080605024730100_micit24","doi-asserted-by":"crossref","first-page":"e11","DOI":"10.2105\/AJPH.2011.300557","article-title":"Exposure to natural cold and heat: hypothermia and hyperthermia Medicare claims, United States, 2004\u20132005.","volume":"102","author":"Noe","year":"2012","journal-title":"Am J Public Health"},{"issue":"2","key":"2026080605024730100_micit25","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.annemergmed.2009.11.022","article-title":"Emergency Department Care in the United States: A Profile of National Data Sources.","volume":"56","author":"Owens","year":"2010","journal-title":"Ann Emerg Med"},{"key":"2026080605024730100_micit26","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1192\/bjp.bp.111.100404","article-title":"Temperature-related deaths in people with psychosis, dementia and substance misuse.","volume":"200","author":"Page","year":"2012","journal-title":"Br J Psychiatry"},{"key":"2026080605024730100_micit27","unstructured":"Pitts SR, Niska RW, Xu J, Burt CW, Pitts SR, Niska RW, et al.\n          \n          2008. National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary. National health statistics reports No. 7. Hyattsville, MD: National Center for Health Statistics.Available: http:\/\/www.cdc.gov\/nchs\/data\/nhsr\/nhsr007.pdf [accessed 30 September 2014]."},{"issue":"1","key":"2026080605024730100_micit28","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/FCH.0b013e3181c4e2fa","article-title":"Nonfatal natural and environmental injuries treated in emergency departments, United States, 2001\u20132004.","volume":"33","author":"Sanchez","year":"2010","journal-title":"Fam Community Health"},{"key":"2026080605024730100_micit29","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1136\/bjsm.2004.013466","article-title":"Cooling methods used in the treatment of exertional heat illness.","volume":"39","author":"Smith","year":"2005","journal-title":"Br J Sports Med"},{"issue":"3","key":"2026080605024730100_micit30","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/S1524-9042(02)54211-9","article-title":"Temperature changes, temperature extremes, and their relationship to emergency department visits and hospitalizations for sickle cell crisis.","volume":"4","author":"Smith","year":"2003","journal-title":"Pain Manag Nurs"},{"issue":"3","key":"2026080605024730100_micit31","first-page":"143","article-title":"The healthcare cost and utilization project: an overview.","volume":"5","author":"Steiner","year":"2002","journal-title":"Eff Clin Pract"},{"issue":"1","key":"2026080605024730100_micit32","first-page":"39","article-title":"Fever versus hyperthermia.","volume":"38","author":"Stitt","year":"1979","journal-title":"Fed Proc"},{"key":"2026080605024730100_micit33","unstructured":"U.S. Census Bureau.\n          \n          2013. Health Insurance Historical Tables\u2014HIB Series.Available: http:\/\/www.census.gov\/hhes\/www\/hlthins\/data\/historical\/HIB_tables.html [accessed 12 November 2013]."},{"key":"2026080605024730100_micit34","unstructured":"U.S. Environmental Protection Agency.\n          \n          2010. Climate Change Indicators in the United States. 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