Skip to main content

Fatal heat stroke in children found in parked cars: autopsy findings

Abstract

A common and unfortunate cause for heat stroke-related deaths in children is entrapment in closed vehicles. The aim of this study was to analyze the pathological consequences of such grave events. Autopsy reports of all children that were brought to a national forensic medicine center after being found dead in closed vehicles over a 21-year period (1995–2015) were reviewed. Data extracted were the circumstances of the events, child age, sex, height and weight, time, date and duration of entrapment, and environmental temperatures at the time of entrapment and the autopsy findings. Eight deceased children were brought to the forensic medicine center for autopsy, and seven families consented to the procedure. Autopsy findings included diffuse petechiae and hemorrhages of serosal membranes (n = 7/7) and lung congestion (n = 3/7).

Conclusion: Typical autopsy findings following classical heat stroke in children include diffuse petechiae and hemorrhages and lung involvement. These findings are similar to those reported in adults that had died following exertional heat stroke—a very different mechanism of heat accumulation. Prevention of future events can possibly be obtained by public education on the rapid heating of closed vehicles, the vulnerability of children to heat, and the caregiver role in child entrapment.

What is Known:
A common and unfortunate cause for heat stroke-related deaths in children is entrapment in closed vehicles. The pathological consequences of such grave events have not been previously reported.
What is New:
This study is the first to describe autopsy findings from children who were found dead in parked cars.
Autopsy findings included diffuse petechiae hemorrhages of serosal membranes and lung congestion.
These findings are identical to those seen in adults following exertional heat stroke.

This is a preview of subscription content, access via your institution.

Abbreviations

CHS:

Classical heat stroke

EHS:

Exertional heat stroke

INCFM:

Israel National Center of Forensic Medicine

References

  1. Armstrong LE, Casa DJ, Millard-Stafford M, Moran DS, Pyne SW, Roberts WO (2007) American College of Sports Medicine position stand. Exertional heat illness during training and competition. Med Sci Sports Exerc 39:556–560

    Article  PubMed  Google Scholar 

  2. Booth JN 3rd, Davis GG, Waterbor J, McGwin G Jr (2010) Hyperthermia deaths among children in parked vehicles: an analysis of 231 fatalities in the United States, 1999–2007. Forensic Sci Med Pathol 6:99–105

    Article  PubMed  Google Scholar 

  3. Bouchama A, Dehbi M, Mohamed G, Matthies F, Shoukri M, Menne B (2007) Prognostic factors in heat wave related deaths: a meta-analysis. Arch Intern Med 167:2170–2176

    Article  PubMed  Google Scholar 

  4. Bouchama A, Knochel JP (2002) Heat stroke. N Engl J Med 346:1978–1988

    CAS  Article  PubMed  Google Scholar 

  5. Falk B (1998) Effects of thermal stress during rest and exercise in the pediatric population. Sports Med 25:221–240

    CAS  Article  PubMed  Google Scholar 

  6. Ferrara P, Vena F, Caporale O, Del Volgo V, Liberatore P, Ianniello F, Chiaretti A, Riccardi R (2013) Children left unattended in parked vehicles: a focus on recent Italian cases and a review of literature. Ital J Pediatr 39:71

    Article  PubMed  PubMed Central  Google Scholar 

  7. Grundstein A, Dowd J, Meentemeyer V (2010) Quantifying the heat-related hazard for children in motor vehicles. Bull Am Meteorol Soc 91:1183–1191

    Article  Google Scholar 

  8. Grundstein AJ, Duzinski SV, Dolinak D, Null J, Iyer SS (2015) Evaluating infant core temperature response in a hot car using a heat balance model. Forensic Sci Med Pathol 11:13–19

    Article  PubMed  Google Scholar 

  9. Guard A, Gallagher SS (2005) Heat related deaths to young children in parked cars: an analysis of 171 fatalities in the United States, 1995–2002. Inj Prev 11:33–37

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. Hiss J, Kahana T, Kugel C, Epstein Y (1994) Fatal classic and exertional heat stroke—report of four cases. Med Sci Law 34:339–343

    CAS  PubMed  Google Scholar 

  11. King K, Negus K, Vance JC (1981) Heat stress in motor vehicles: a problem in infancy. Pediatrics 68:579–582

    CAS  PubMed  Google Scholar 

  12. Malamud N, Haymaker W, Custer RP (1946) Heat stroke: a clinic-pathologic study of 125 fatal cases. Mil Surg 99:397–448

    CAS  PubMed  Google Scholar 

  13. Rav-Acha M, Hadad E, Epstein Y, Heled Y, Moran DS (2004) Fatal exertional heat stroke: a case series. Am J Med Sci 328:84–87

    Article  PubMed  Google Scholar 

Download references

Author contributions

Berliz Adato, Yuval Heled, and Yoram Epstein conceived the study and participated in study design, acquisition, and interpretation of data. Hadas Gips participated in acquisition and interpretation of data. Gal Dubnov-Raz participated in interpretation and analysis of data and initial drafting of the article. All authors revised the manuscript critically for important intellectual content and gave final approval of the version to be published.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gal Dubnov-Raz.

Ethics declarations

Funding

No funding was obtained for this study.

Conflicts of interests

All authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Communicated by Mario Bianchetti

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Adato, B., Dubnov-Raz, G., Gips, H. et al. Fatal heat stroke in children found in parked cars: autopsy findings. Eur J Pediatr 175, 1249–1252 (2016). https://doi.org/10.1007/s00431-016-2751-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-016-2751-5

Keywords

  • Automobile
  • Autopsy
  • Death
  • Heat stroke
  • Pediatrics