Citation

Forristal C, Van Aarsen K, Columbus M, Wei J, Vogt K, Mal S. Prehosp. Emerg. Care 2019; ePub(ePub): 1-8.

Affiliation

Division of Emergency Medicine, Department of Medicine , Western University , London , Canada.

Copyright

(Copyright © 2019, National Association of EMS Physicians, Publisher Informa - Taylor and Francis Group)

DOI

10.1080/10903127.2019.1599474

PMID

30945956

Abstract

INTRODUCTION: Hypothermia in severe trauma patients can increase mortality by 25%. Active warming practices decrease mortality and are recommended in the Advanced Trauma Life Support (ATLS) guidelines. Despite this, many emergency medical services (EMS) vehicles do not carry equipment necessary to perform active warming. The intent of this study was to determine the rate of hypothermia in severe trauma patients upon major trauma centre (MTC) arrival, as well as to characterize factors associated with hypothermia in trauma in order to devote potential resources to those at highest risk.

METHODS: This single-centre retrospective chart review included adults (age ≥18) in the local trauma registry (trauma team activation or injury severity score ≥12) from Jan 2009-Jun 2016. Logistic regression was used to identify predictors of hypothermia on MTC arrival.

RESULTS: A total of 3070 patient charts were reviewed, of which 159 (5.2%) were hypothermic. Multivariate logistic regression identified seven factors that were significantly associated with hypothermia on MTC arrival in severe trauma. Risk factors for hypothermia on MTC arrival after severe trauma included: intubation pre-MTC, increased number of co-morbidities, and increased injury severity. Conversely, protective factors against hypothermia were: higher initial SBP, penetrating injury, referral to MTC, and higher ambient outdoor temperatures. Median length of stay in hospital was 7 days for hypothermic patients compared to 4 days for normothermic patients (Δ 3 days; p < 0.001). Only 69.2% of hypothermic patients survived to discharge compared to 93.9% of normothermic patients (Δ 24.7%; χ²= 133.4, p < 0.001).

CONCLUSIONS: This retrospective study of hypothermia in major trauma patients found a rate of hypothermia of 5%. Factors associated with higher risk of hypothermia include pre-MTC intubation, high ISS, multiple comorbidities, low SBP, non-penetrating mechanism of injury, and being transferred directly to MTC, and colder outdoor temperature. Avoidance of hypothermia is imperative to the management of major trauma patients. Prospective studies are required to determine if pre-hospital warming in these high-risk patients decreases the rate of hypothermia in major trauma and improves patient outcomes.

Language: en

Keywords

Hypothermia; Prehospital Emergency Care; Trauma