Abstract
OBJECTIVES: Climate change has led to more frequent and intense heat events with dramatic increases in heat illness and heat-related deaths. We compared demographic characteristics such as age, sheltering status, and underlying health conditions that contribute to susceptibility to extreme heat. We described the clinical course of these patients, presenting over a 12-year span, who were diagnosed with heat-related illness, to inform local risk stratification. METHODS: We conducted retrospective chart abstraction of encounters between January 1, 2012-December 31, 2023, which included adults 18-89 years of age, presenting to a single hospital system's emergency department (ED), with an International Classification of Diseases, 10th Revision, discharge diagnosis within the T67 heat-related diagnosis code family. We compared demographic characteristics to baseline ED presentations and summarized clinical characteristics in frequencies. Trends were described over time juxtaposed with temperature data. RESULTS: The 141 patients with a heat illness diagnosis were older, with a mean age of 53, and were more likely to be male (81.6%), White (51.8%), or Native American (7.8%) as compared to adult (18-89 years of age) all-comer ED presentations. Patients with a heat illness often carried co-occurring diagnoses of contact burns (38.3%) or rhabdomyolysis (25.5%). Common chronic comorbid conditions included cardiovascular disease (33.3%) and substance use disorder (22.0%). Antipsychotics (22.0%), laxatives (24.1%), and beta blockers (15.6%) were frequent home medications among heat-affected patients. Of the patients who were the most critically ill from heat illness, 35.5% required ED intubation and 95.7% were admitted, with 45.9% of those requiring intensive care. While most were discharged to self-care (59.3%), 26.7% required skilled nursing care at discharge. CONCLUSION: This review describes the characteristics and clinical course of patients diagnosed with heat illness over more than a decade of increasingly frequent and extreme heat in Phoenix, AZ. It provides a unique and sizeable cohort that can guide the surveillance and treatment of heat illness. We highlight clinical trends and gaps in clinical heat illness data to identify vulnerabilities and protective factors among our patients.