Using near real-time morbidity data to identify heat-related illness prevention strategies in North Carolina

Rhea S, A Ising, AT Fleischauer, L Deyneka, H Vaughan-Batten, A Waller.J Community Health 2012;37:495–500

Many studies over the last 20 years or so have shown large increases in morbidity and mortality during heat waves. Warnings of the potential dangers would allow action to be taken: those at risk can seek cooler environments and increase water intake and those responsible for vulnerable older adults and young children can take the necessary precautions.

This study examined the possibility that monitoring of emergency department (ED) visits for heat-related illness could data provide information that could be useful in directing prevention efforts.  The state registration system in North Carolina allowed electronic ED data to be collected every 12 hours from 116 hospitals across the state, allowing a near real time picture of heat-related problems.

The mean number of heat-related ED visits per day was compared to the maximum daily temperature. The authors found that the mean daily number of heat-related visits to ED’s increased by 2.5 for each 1°C increase from 32°C to 37°C and by 28.4 for each 1°C increase from 37°C to 38°C. The percentage of heat-related visits was highest in early summer (June), when it accounted for an average of 0.25% of all visits over the three year (2008-2010) monitoring period. 15–18 year-olds had the highest percentage of heat-related visits and were often seen for sports-related heat exposures.

Heat-related visits associated with occupational tasks were more common than other causes in 19–45 year-olds. Individuals over 65 years were more likely to be admitted to the hospital than younger individuals. The authors concluded that monitoring of this near real-time morbidity data may allow targeting of relevant prevention strategies.

The results of the present study suggest that prevention efforts in North Carolina should be emphasised in early summer and should be aimed especially at adolescents involved in organized sports, young adults with outdoor occupations, and seniors.

Abstract

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Timely public health interventions reduce heat-related illnesses (HRIs). HRI emergency department (ED) visit data provide near real-time morbidity information to local and state public health practitioners and may be useful in directing HRI prevention efforts. This study examined statewide HRI ED visits in North Carolina (NC) from 2008-2010 by age group, month, ED disposition, chief complaint, and triage notes. The mean number of HRI ED visits per day was compared to the maximum daily temperature. The percentage of HRI ED visits to all ED visits was highest in June (0.25%). 15-18 year-olds had the highest percentage of HRI visits and were often seen for sports-related heat exposures. Work-related HRI ED visits were more common than other causes in 19-45 year-olds. Individuals ≥65 years were more likely admitted to the hospital than younger individuals. The mean daily number of HRI ED visits increased by 1.4 for each 1°F (degree Fahrenheit) increase from 90°F to 98°F and by 15.8 for each 1°F increase from 98°F to 100°F. Results indicate that HRI prevention efforts in NC should be emphasized in early summer and targeted to adolescents involved in organized sports, young adults with outdoor occupations, and seniors. At a maximum daily temperature of 98°F, there was a substantial increase in the average daily number of HRI ED visits. ED visit data provide timely, sentinel HRI information. Analysis of this near real-time morbidity data may assist local and state public health practitioners in identification of HRI prevention strategies that are especially relevant to their jurisdictions.

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