ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity

The editorial board of Current Sports Medicine Reports and ACSM Pronouncements and Publications Committees acknowledge and understands the concerns raised with the published pronouncement ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity. The board addressed these concerns using Committee on Publications Ethics (COPE) standard publishing protocols. For more on this process and the results, please review the corrigendum below.

In the article “ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity,” by William O. Roberts, M.D.,M.S., FACSM; Lawrence E. Armstrong, Ph.D., FACSM; Michael N. Sawka, Ph.D., FACSM, FAPS; Susan W. Yeargin, Ph.D., ATC; Yuval Heled, Ph.D., FACSM; and Francis G. O’Connor, M.D., MPH, FACSM, FAMSSM (Current Sports Medicine Reports: September 2021–Volume 20–Issue 9–p 470-484 doi: 10.1249/JSR.0000000000000878), several tables and accompanying text and references have been replaced with updated information to address concerns about specific tables and sections of text that were identified as potentially confusing. Clarifying text has been added to the Rapid Assessment and Cooling and Administrative Strategies sections. Further, detail also has been added to Tables 1, 2, 7, and 8, as well as Figure 3. The reference section also has been updated to reflect additional supporting citations.

This corrigendum serves to notify that the entire article has been replaced to address the noted changes.

As this is an ACSM Pronouncement (ACSM Expert Consensus Statement), further information about the writing group and review processes for ACSM pronouncements, as well as processes related to this article and corrigendum, are being provided for transparency.

Following the original publication in September 2021, a reviewer expressed concern they had not seen a response to their peer review comments prior to the article being published and several points of feedback raised during the peer review process had not been addressed in the published version of the article. The reviewer further requested that the article be retracted based on the concern that a rigorous peer-review process had not been used.

Two processes were initiated to determine the next steps:

1. Five additional content experts were secured by ACSM Board President L. Bruce Gladden, Ph.D., FACSM, to review the article.
2. An external evaluation of the peer review process was conducted by ACSM's Publications Committee.

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After reviewing the overall process and reviewer comments, it was determined that the threshold for retracting an article was not met in this case, and a corrigendum was warranted. The writing group and journal Editor-in-Chief Shawn Kane, M.D., FACSM made this decision in consultation with ACSM’s Publications Committee and based on the feedback from the five independent reviewers and consulting the Committee on Publications Ethics (COPE) guidelines.
   
Based on the feedback from the five additional content experts, specific tables and sections of text were identified as potentially confusing. The writing group was asked to revise the article, add detail to specific sections, and eliminate any confusing passages based on the reviewer comments. The article was sent back to the five content experts after revision. All content experts recommended the updated article be submitted for publication.

The writing group worked toward consensus on the updated article. Full consensus was not met — five of the six members of the writing group approved the revised article.

One member of the writing group (author Susan W. Yeargin, Ph.D., ATC), cast a dissenting vote to the manuscript text based on the following reasons: 1) cold/ice water immersion is not overtly clarified as the standard of care for exertional heat stroke throughout the text, 2) the cooling rate of 0.15°C is not explicitly clarified as a threshold clinicians should use when choosing cooling methods to minimize morbidity and mortality and therefore cooling rates below this would be considered inferior, 3) the goal of exertional heat stroke treatment to reduce body temperature below 40.5°C within 30 min is not included within the manuscript, and 4) a full return of CNS function should not be used to determine when cooling should cease in exertional heat stroke victims when rectal temperatures are not available. Time, cooling rate of method being used, and CNS should all be used to guide treatment time when rectal temperature is not available.

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At the time of the original pronouncement submission, the ACSM writing group and review process for ACSM Pronouncements was as follows:

1. Writing group completes work on the pronouncement; all writing group members must sign the standard, ICMJE-compliant Copyright Transfer Agreement Form when submitting the manuscript to the journal.
2. ACSM Pronouncements Committee reviews the final draft of the article.
3. Article undergoes peer review at the target journal:
   1. Position Stands undergo 2 rounds of peer review using five to seven reviewers;
   2. All other pronouncements, in an effort to be timely and nimble, do not have a predetermined specific number of reviewers, nor a specific number of rounds of peer review.
4. The writing group addresses all reviewer comments.
5. Once accepted by the respective journal editor-in-chief, the article is reviewed, discussed, and approved by the ACSM Administrative Council/Board of Trustees to be published as an official pronouncement of ACSM.

Variances from the above in the writing group and peer review process for this consensus statement pronouncement were identified:

1. There was one round of peer review, with two reviewers and the editor-in-chief serving as an additional reviewer.
2. Consensus was not met across the entire writing group even though the ICMJE-compliant Copyright Transfer Agreement Form was signed by all authors.

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The external review and evaluation of the peer review process determined that the policies and procedures for Current Sports Medicine Reports at the time did not require two rounds of peer review nor returning the revised version of the article to the peer reviewers.

As a result of this situation, a small working group was assembled comprised of the chairs and members from the ACSM Pronouncements Committee, the ACSM Evidence Based-Practice Committee, ACSM’s Publications Committee, and ACSM publishing staff. This group reviewed the current processes and has instituted additional new protocols for all future ACSM pronouncements, which will replace step 3 above:

1. All ACSM pronouncements will now go through two rounds of peer review.
2. Position Stands will still require five to seven reviewers. All other pronouncements will also require five to seven reviewers, with the exception of call-to-action statements, which will require three to five reviewers.

In addition, processes are being reviewed and will be subsequently revised to handle situations where writing group member(s) are not in agreement on the content.

The retraction request was evaluated again after the article was updated based on the reviewer comments and the decision to not retract and issue a corrigendum was confirmed