Heatstroke presentations to urban hospitals during BC's extreme heat event: lessons for the future

BACKGROUND

Climate change is leading to more extreme heat events in temperate climates that typically have low levels of preparedness. Our objective was to describe the characteristics, treatments, and outcomes of adults presenting to hospitals with heatstroke during BC's 2021 heat dome.

METHODS

We conducted a review of consecutive adults presenting to 7 hospitals in BC's Lower Mainland. We screened the triage records of all patients presenting between June 25th and 30th, 2021 for complaints related to heat, and reviewed the full records of those who met heatstroke criteria. Our primary outcome was in-hospital mortality. We used Mann-Whitney U tests and logistic regression to investigate associations between patient and treatment factors and mortality.

RESULTS

Among 10,247 consecutive presentations to urban hospitals during the extreme heat event, 1.3% (139; 95% confidence intervals [CI] 1.1-1.6%) met criteria for heatstroke. Of heatstroke patients, 129 (90.6%) were triaged into the two highest acuity levels. Patients with heatstroke had a median age of 84.4 years, with 122 (87.8%) living alone, and 101 (84.2%) unable to activate 911 themselves. A minority (< 5, < 3.6%) of patients presented within 48 h of the onset of extreme heat. Most patients (107, 77.0%) required admission, and 11.5% (16) died in hospital. Hypotension on presentation was associated with mortality (odds ratio [OR] 5.3).

INTERPRETATION

Heatstroke patients were unable to activate 911 themselves, and most presented with a 48-h delay. This delay may represent a critical window of opportunity for pre-hospital and hospital systems to prepare for the influx of high-acuity resource-intensive patients.

To believe or not to believe? How voice and accent information in speech alter listener impressions of trust

Our decision to believe what another person says can be influenced by vocally expressed confidence in speech and by whether the speaker–listener are members of the same social group. The dynamic effects of these two information sources on neurocognitive processes that promote believability impressions from vocal cues are unclear. Here, English Canadian listeners were presented personal statements ( She has access to the building) produced in a confident or doubtful voice by speakers of their own dialect (in-group) or speakers from two different “out-groups” (regional or foreign-accented English). Participants rated how believable the speaker is for each statement and event-related potentials (ERPs) were analysed from utterance onset. Believability decisions were modulated by both the speaker’s vocal confidence level and their perceived in-group status. For in-group speakers, ERP effects revealed an early differentiation of vocally expressed confidence (i.e., N100, P200), highlighting the motivational significance of doubtful voices for drawing believability inferences. These early effects on vocal confidence perception were qualitatively different or absent when speakers had an accent; evaluating out-group voices was associated with increased demands on contextual integration and re-analysis of a non-native representation of believability (i.e., increased N400, late negativity response). Accent intelligibility and experience with particular out-group accents each influenced how vocal confidence was processed for out-group speakers. The N100 amplitude was sensitive to out-group attitudes and predicted actual believability decisions for certain out-group speakers. We propose a neurocognitive model in which vocal identity information (social categorization) dynamically influences how vocal expressions are decoded and used to derive social inferences during person perception.

Corticosteroids in sepsis: an updated systematic review and meta-analysis (protocol)

INTRODUCTION

Sepsis is associated with a dysregulated host response to infection and impaired endogenous corticosteroid metabolism. As such, therapeutic use of exogenous corticosteroids is a promising adjunctive intervention. Despite a large number of trials examining this research question, uncertainty persists regarding the effect of corticosteroids on survival in sepsis. Several large randomised controlled trials have been published recently prompting a re-evaluation of the available literature.

METHODS AND ANALYSIS

A rigorous and reproducible search and screening process from a Cochrane review on the same topic was comprehensive to October 2014. We will search MEDLINE, EMBASE, LILACS, the Cochrane trial registry and clinicaltrials.gov for eligible randomised controlled trials investigating the use of corticosteroids in patients with sepsis from September 2014. Outcomes have been chosen by a semi-independent guideline panel, created in the context of a parallel BMJ Rapid Recommendation on the topic. This panel includes clinicians, content experts, methodologists and patient representatives, who will help identify patient-important outcomes that are critical for deciding whether to use or not use corticosteroids in sepsis. Two reviewers will independently screen and identify eligible studies; a third reviewer will resolve any disagreements. We will use RevMan to pool effect estimates from included studies for each outcome using a random-effect model. We will present the results as relative risk with 95% CI for dichotomous outcomes and as mean difference or standardised mean difference for continuous outcomes with 95% CI. We will assess the certainty of evidence at the outcome level using the Grading of Recommendations, Assessment, Development and Evaluation approach. We will conduct a priori subgroup analyses, which have been chosen by the parallel BMJ Rapid Recommendation panel.

ETHICS AND DISSEMINATION

The aim of this systematic review is to summarise the updated evidence on the efficacy and safety of corticosteroids in patients with sepsis.

TRIAL REGISTRATION NUMBER

CRD42017058537.