A functional return-to-play progression after exertional heat stroke in a high school football player

Objective: To present a functional return-to-play (RTP) progression after exertional heat stroke (EHS) in a 17-year-old high school football defensive end (height ¼ 185 cm, mass ¼ 145.5 kg). Background: The patient had no pertinent medical history but moved to a warm climate several days before the EHS occurred. After completing an off-season conditioning test (14- 3 110-yd [12.6- 3 99.0-m] sprints) on a warm afternoon (temperature ¼ approximately 348C [938F], relative humidity ¼ 53%), the patient collapsed. An athletic trainer (AT) was called to the field, where he found the patient conscious but exhibiting central nervous system dysfunction. Emergency medical services were summoned and immediately transported the patient to the hospital. Differential Diagnosis: Exertional heat stroke, heat exhaustion, exertional sickling, rhabdomyolysis, and cardiac arrhythmia. Treatment: The patient was immediately transported to a hospital, where his oral temperature was 39.68C (103.38F). He was transferred to a children’s hospital and treated for rhabdomyolysis, transaminitis, and renal failure. He was hospitalized for 11 days. After a physician’s clearance once the laboratory results normalized, an RTP progression was completed. The protocol began with light activity and progressed over 3 weeks to full football practice. During activity, an AT monitored the patient’s gastrointestinal temperature, heart rate, rating of perceived exertion, fluid consumption, and sweat losses. Uniqueness: Documentation of RTP guidelines for young athletes is lacking. We used a protocol intended for the football setting to ensure the athlete was heat tolerant, had adequate physical fitness, and could safely RTP. Despite his EHS, he recovered fully, with no lasting effects, and successfully returned to compete in the final 5 games of the season. Conclusions: Using a gradual RTP progression and close monitoring, a high school defensive end successfully returned to football practice and games after EHS. This case demonstrates the feasibility of implementing a safe RTP protocol after EHS and may serve as a guide to ATs working in the high school setting. This case also highlights the need for more research in this area.