**2. Epidemiology**

In the United States, from 2006 to 2010, it was reported to have caused at least 3332 deaths. Heat stroke mortality is correlated with the degree of body temperature elevation, time of initiation of cooling, and number of organs affected [2].

Various aspects can affect the incidence of heat stroke, including gender, age, geographic location, and occupation. Heat stroke is higher in females, with a female-tomale ratio of up to 2.89 versus 0.98–1.98 per 1000 person-years [3].

Heat stroke has different rates of occurrence in different geographic areas. During the European heat wave in 2022, thousands of people died due to heat stroke. Heat stroke mortality is expected to rise by 2.5 times by 2050 [3].

## **3. Classification and definition**

Bouchama's definition is the most commonly accepted for heat stroke, and it is a rise in core body temperature of more than 40°C with hot, dry skin and central nervous system abnormalities. Another alternative definition of heat stroke is the hyperthermia associated with SIRS (Systemic Inflammatory Response Syndrome), which causes multiple organ dysfunction and mainly central nervous system dysfunction [4].

The JAAM heat stroke committee (Japanese Association for Acute Medicine) heat stroke committee, after analysis of the data collected by the working group, modified the heat stroke definition. Heat stroke is defined as patients exposed to high environmental temperatures who meet one or more of the following criteria [5]:

1.Glasgow Coma Scale (GCS) score of ≤14,

2.Creatinine or total bilirubin levels of ≥1.2 mg/dL,

3.JAAM DIC score of ≥4.

#### **4. Classification**

Heat stroke is typically classified into two groups depending upon the presence or absence of exertion [4, 5].


Non-exertional or classic heat stroke occurs in individuals at extremes of age, elderly over 70, or children in the vehicle. The main issue in this type of heat stroke is an anatomical or physiological predisposition or the patient's comorbidities, all of which impair thermoregulation, prevent removal from a hot environment, or interfere with access to hydration or attempts at cooling. Prescribed or recreational medication, anticholinergics, beta-blockers or diuretics, and cocaine and alcohol, respectively, also contribute to non-exertional heat stroke. Exertional heat stroke occurs when a healthy individual heavily exercises at a higher ambient temperature.
