Sharp Rise in Heat-Related ED Visits for Kids in Texas

ORLANDO — Heat-related emergency department (ED) visits soared over the last 12 years, a retrospective study at two large Texas-based children’s hospitals showed.

As a proportion of total ED encounters, heat-related visits increased by 170% from 2012 (4.3 per 10,000) to 2023 (11.6 per 10,000, P=0.01), reported Taylor Merritt, MD, of the University of Texas Southwestern Medical Center and Children’s Health in Dallas. Overall, there were 542 heat-related ED encounters during that time period.

Though heat-related visits — while rising — were a low proportion of ED encounters overall, it is “important for us to know…how heat is affecting our children,” especially “given increasing temperatures,” Merritt said at the American Academy of Pediatrics (AAP) annual meeting. Summer 2023 was the second-hottest on record in Texas, with an average high of 98.3°F, according to the Dallas Morning News.

Merritt noted that climate change has brought about record-breaking summer temperatures in the U.S. and globally, and exposure to extreme heat is associated with increased heat-related morbidity and mortality, especially among children. Yet pediatric data on trends over time and outcomes of heat-related illness are lacking, Merritt said.

To get a better sense of those trends, Merritt and colleagues looked at pediatric ED records from 2012 to 2023 for heat-related diagnoses (including “excessive natural heat” and “effects of heat and light”) and compared those with rhabdomyolysis diagnosis.

They used rhabdomyolysis — a condition in which damaged muscle tissue releases proteins and electrolytes into the blood, potentially impacting organs — as a comparator because it can lead to permanent damage or death and heat exposure is among the risk factors for it.

Overall, among heat-related visits, 418 had heat-specific diagnoses (77%) and 131 had a rhabdomyolysis diagnosis (24%), Merritt reported.

Though most of the heat-specific encounters identified by Merritt and colleagues resulted in an ED discharge (96%), most of the rhabdomyolysis encounters (63%) resulted in hospital admission, she noted.

Compared to the rhabdomyolysis group, the heat-specific group was more likely to be younger. For instance, 55% of the heat-specific group was under age 12 years, while 70% of the rhabdomyolysis group was age 12-18. Additionally, the heat-specific group was more likely to be Hispanic (38% vs 24%), and use government-based insurance (54% vs 44%).

The researchers also found that summer months with higher peak temperatures were associated with higher heat-related ED volume (r=0.66, P<0.001).

Overall, most visits for heat-related illness (62%) were for males, and just over half were for those ages 12-18. In addition, 35% of patients identified as Hispanic, 30% as non-Hispanic Black, 26% as non-Hispanic white, and 8% as other. Slightly more than half had government insurance.

Aside from heat-related ED visits accounting for a small proportion of ED encounters overall, study limitations included the fact that it was done at a single health system and for a limited time period. Also, there was limited chart review data available. And other causes of rhabdomyolysis, such as infections, could not be excluded, Merritt noted.

Going forward, it will be “really useful to look at longer periods and over different parts of the country,” to gain a “fuller picture” of the impact of heat on children, Merritt said.