Hypothermia on Admission Predicts Poor Outcomes in Adult Trauma Patients

Hypothermia on Admission Predicts Poor Outcomes in Adult Trauma Patients

Authors: Anna Mary Jose, Aryan Rafieezadeh, Muhammad Zeeshan, et al.
Journal: Injury, 2024

Conclusions

• Hypothermia on admission is independently associated with:
• Increased mortality
• Higher in-hospital complications
• Prolonged ICU and hospital stays
• Isolated TBI Patients: Pre-hospital hypothermia remains a significant predictor of mortality.
• Rewarming Interventions: Effective in reducing mortality and resource utilization.

Methods

• Design: Retrospective cohort study using the ACS-TQIP database (2017–2021).
• Population: Adult trauma patients.
• Exclusion Criteria:
• Incomplete data
• Burns
• Inter-facility transfers
• Documented as dead on arrival
• Definitions:
• Hypothermia (HT): Temperature <35°C on admission
• Normothermia (NT): Temperature 35–40°C
• Primary Outcomes:
• Mortality
• ICU LOS
• Hospital LOS
• Duration of mechanical ventilation
• In-hospital complications
• Statistical Analysis: Multivariable regression analysis to adjust for confounders.

Results

• Total Patients Included: 3,043,030
• Hypothermic Patients: 1%
• Key Findings:
• Injury Severity: HT patients had more severe injuries.
• In-Hospital Complications: HT: 17.1% vs. NT: 4.5%
• ICU Length of Stay: HT: 4 (2–9) days vs. NT: 3 (2–5) days
• Hospital Length of Stay: HT: 5 (2–12) days vs. NT: 4 (2–6) days
• Mortality: HT: 23.4% vs. NT: 2.3%
• Independent Predictors of Mortality:
• HT increased mortality risk (OR: 1.934; 95% CI: 1.858–2.013)
• Isolated Traumatic Brain Injury (TBI): HT remained an independent predictor of mortality (OR: 1.728; 95% CI: 1.600–1.867)
• Effect of Rewarming:
• Lower mortality
• Shorter ICU and hospital LOS