UMEM Educational Pearls

Takeaways

Every year, numerous children die of non-exertional heatstroke after being left in motor vehicles in the United States. Per data obtained from the national nonprofit KidsAndCars.org, the average number of pediatric vehicular heatstroke deaths is 39 per year since 1990. In 2018, this number peaked at 54 pediatric deaths. Prior studies show that the interior temperature of a closed vehicle rises quickly within minutes of closing the doors and windows. This rapid change occurs even on days with cooler ambient temperatures (20s °C/70s °F): the interior temperature of a car may still reach 117F within an hour.

Children, particularly infants and toddlers, are at increased risk for heat illness due to several physiologic and developmental factors:

-       Unable to escape hot environments or to self-hydrate

-       Lack mature thermoregulatory systems

o   Have lower rate of sweat production than adults

-       Have higher basal metabolic rates than adults

-       Have higher body surface area:mass ratio --> absorb heat faster in hot environments

Bottom line:  ED providers can be instrumental in giving anticipatory guidance on vehicular heatstroke in children during the warmer seasons:

-        Educate caregivers to “Look before you Lock”

-       Suggest that the caregiver place a valuable object (phone, employee badge, handbag) in the back seat when traveling with a child

-       Remind caregiver of the dangers of intentionally leaving a child in the car for any reason, even during cooler spring/summer days.

In-Depth

A recent retrospective cohort study (Hammett et al.) of 554 pediatric victims (aged <14 years) who died of heatstroke in a motor vehicle was conducted using KidsAndCars.org data. This study is the largest to date to describe this US subset of pediatric fatalities.

Results:

-       Nearly half of the cases occurred when the ambient temperature was >90°F. However, 10% cases occurred when the ambient temperature was < 80°F.

-       Most incident cases (~40%) occurred in home parking areas > nonresidential parking areas> daycare centers parking.

-       The mean victim age was 16.4 months. Most (99%) victims were less than 5 years of age.

-       Male children were more common victims (54% cases) than female children.

-       Most victims (78%) were left unknowingly in vehicles by their caregivers. For those victims left intentionally in vehicles, caregivers’ reasons for leaving the child in the vehicle were the caregivers’ need to attend work or school or desire to allow the child to keep sleeping.

-        A single caregiver was most commonly responsible for leaving the child in the vehicle (89% cases), with the victim’s mother being the most often responsible.

References

https://www.kidsandcars.org/wp-content/uploads/2020/01/Heatstroke-fact-sheet.pdf

Hammett, D. L., Kennedy, T. M., Selbst, S. M., Rollins, A. & Fennell, J. E. Pediatric Heatstroke Fatalities Caused by Being Left in Motor Vehicles. Pediatric Emergency Care, (2020).


Attachments

Hammett._Pediatric_Heatstroke_Fatalities_Caused_by_Being_Left_in_Cars.pdf (581 Kb)