Fatal Exertional Heat Stroke Trends in Secondary School Sports From 1982 Through 2022.

Background: Exertional heat stroke (EHS) is a leading cause of secondary school sport-related death; however, a longitudinal analysis on observed trends is lacking. Our purpose was to describe EHS deaths in United States secondary school athletes since the 1982/1983 academic year.

Hypothesis: EHS deaths will be primarily represented by football athletes and have a stable or increasing trend across a decade-by-decade analysis.

Study Design: Descriptive epidemiology study.

Level Of Evidence: Level 4.

Methods: EHS deaths in secondary school sports from July 1, 1982 through June 30, 2022 captured in the National Center for Catastrophic Sports Injury Research database were included (n = 67). Chi-square test of goodness of fit (alpha = 0.05), incidence rate ratios, and 95% CIs of differences in number of deaths between the 4 decades are reported.

Results: Of 67 deaths, 66 (98.5%) were male. Ages ranged from 13 to 18 years. Football accounted for 63 (94%) of deaths, with basketball (n = 2), soccer (n = 1), and track and field (n = 1) accounting for the remainder. The southern region had the largest number of deaths, n = 50 (74.6%). Most deaths occurred in August (n = 38), followed by July (n = 15) and September (n = 9). Stratified into 4 separate 10-year periods, the proportion of EHS deaths differed significantly across time ((3, n = 67) = 8.72; = 0.03). The period 2002-2011 had the highest number of EHS deaths (n = 26), 1982-1991 had 9, while both 1992-2011 and 2012-2021 had 16 deaths.

Conclusion: The most recent decade shows a 38% reduction from the peak decade (2002-2011, n = 26), but remains similar to 1982-1991.

Clinical Relevance: Continued efforts are required to prevent catastrophic sport-related death due to EHS. Secondary school EHS deaths are overwhelmingly represented by football, most commonly in August, and in the south. This emphasizes the need for secondary schools to be equipped with basic tools and policies to saves lives.