BACKGROUND: Exertional heat stroke (EHS) is a leading cause of death in athletes. While there is evidence supporting best practices to prevent death, there is a lack of understanding regarding the clinical presentation of EHS. Therefore, Aim 1 was to describe central nervous system (CNS) function, using the Glasgow Coma Scale (GCS) and signs and symptoms (S&Sx), in EHS patients; Aim 2 was to determine if a relationship exists between rectal temperature (Tre) and GCS in EHS patients. METHODS: A cross sectional research design was utilized by observing EHS patients (defined as >40°C + CNS dysfunction) at an 11.3-km road race. De-identified medical records were provided by the medical director. The primary outcome variables were GCS cumulative score, Tre, and S&Sx (recorded as pre-determined nominal values). Trained, dedicated scribes recorded information on the patient’s medical record. Parametric and non-parametric descriptive statistics were calculated according to data type. A Spearman’s rank correlation was used to determine if a relationship existed between GCS score and Tre. RESULTS: Runners diagnosed with EHS (male=13, female=10) were aged 30 ± 14y (range 15-58y), with an initial Tre of 41.0 ± 0.6°C (40.0-42.1°C) and GCS of 14 ± 3 (4-15). Across evaluation and treatment time points, the maximum Tre was 41.2 ± 0.7°C (40.0-42.6°C) and the worst cumulative GCS scores were 13 ± 4 (0-15). At the initial recording, S&Sx observations included nausea (17.4% of recorded observations), dizziness, irritability, aggressive, headache, and malaise (all 4.3%). Confusion (13%), difficulty remembering (8.7%), and irritability (8.7%) had the highest percent of observations at different time points over the course of evaluation and treatment. A significant correlation did not exist for average Tre and GCS (rs(20)=-0.88, p=0.218), nor with maximum Tre and GCS (rs(20)=-0.34, p=0.144) or minimum Tre and GCS (rs(20)=0.044, p=0.852). CONCLUSIONS: GCS ranged widely for EHS during evaluation and treatment. As a result, there was no relationship between GCS and Tre. Additional S&Sx observations also varied widely, with not one symptom category representing the majority of observations at any time point. Clinicians should be prepared to recognize CNS dysfunction in EHS patients in a variety of ways. GCS may not be a good measure of CNS dysfunction in EHS patients, let alone for clinical decision making.

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