Heat Stroke Burden and Validity of Wearable-Derived Core Temperature Estimation during Elite Military Training.

OBJECTIVES: Exertional heat stroke (EHS) remains a significant health concern while training in hot environments, prompting the development of non-invasive wearable technology for monitoring estimated core temperature (ECT). The objective of this study was to review the effectiveness of an ECT device during elite military training by providing a case series of individuals who developed EHS.

METHODS: This was a retrospective study of EHS cases during high-intensity training while wearing the ECT device, Zephyr BioharnessTM . Data was collected from January 2021 through September 2021 at the Air Force Special Warfare Training pipeline in San Antonio, TX. Rectal temperatures of EHS diagnoses, defined by central nervous system (CNS) dysfunction and rectal temperature approaching or >40 deg C (104 deg F), were compared to ECT reading via Zephyr BioharnessTM . Incidence rates and psychometric properties were calculated using R package.

RESULTS: 47,058 daily peak ECT measurements were collected among 1,364 trainees. 499 trainees flagged as potential EHS by Zephyr BioharnessTM reading >39.7 °C (103.5°F). Incidence of confirmed EHS was 0.8/1000 person-months. Of the 10 confirmed EHS cases (9 males, 1 female; age=23.4 ± 2.7 yrs; BMI=25 ± 2; body fat=13 ± 5%), 8 trainees had a peak ECT reading below 39.7 °C which resulted in a sensitivity of 20%, specificity of 98.9%, positive likelihood ratio (LR) of 18.93 (95% Confidence Interval[CI] 5.5-65.6) and a negative LR of of 0.81 (95% CI 0.6-1.1).

CONCLUSION: ECT had substantial false positive and negative rates. Further studies are needed to validate this technology in other populations, and the algorithm used in this device needs to be refined to better capture the environmental and physical requirements in the special operations population.