Abstract

This study aimed to assess whether hypothermia is an independent predictor of mortality in trauma patients in the condition of defining hypothermia as body temperatures of <36 °C. Data of all hospitalized adult trauma patients recorded in the Trauma Registry System at a level I trauma center between 1 January 2009 and 12 December 2015 were retrospectively reviewed. A multivariate logistic regression analysis was performed in order to identify factors related to mortality. In addition, hypothermia and normothermia were defined as temperatures <36 °C and from 36 °C to 38 °C, respectively. Propensity score-matched study groups of hypothermia and normothermia patients in a 1:1 ratio were grouped for mortality assessment after adjusting for potential confounders such as age, sex, preexisting comorbidities, and injury severity score (ISS). Of 23,705 enrolled patients, a total of 401 hypothermic patients and 13,368 normothermic patients were included in this study. Only 3.0% of patients had hypothermia upon arrival at the emergency department (ED). Compared to normothermic patients, hypothermic patients had a significantly higher rate of abbreviated injury scale (AIS) scores of ≥3 in the head/neck, thorax, and abdomen and higher ISS. The mortality rate in hypothermic patients was significantly higher than that in normothermic patients (13.5% vs. 2.3%, odds ratio (OR): 6.6, 95% confidence interval (CI): 4.86–9.01, p < 0.001). Of the 399 well-balanced propensity score-matched pairs, there was no significant difference in mortality (13.0% vs. 9.3%, OR: 1.5, 95% CI: 0.94–2.29, p = 0.115). However, multivariate logistic regression analysis revealed that patients with low body temperature were significantly associated with the mortality outcome. This study revealed that low body temperature is associated with the mortality outcome in the multivariate logistic regression analysis but not in the propensity score matching (PSM) model that compared patients with hypothermia defined as body temperatures of <36 °C to those who had normothermia. These contradicting observations indicated the limitation of the traditional definition of body temperature for the diagnosis of hypothermia. Prospective randomized control trials are needed to determine the relationship between hypothermia following trauma and the clinical outcome.

Highlights

  • According to the guideline for trauma patients from Advanced Trauma Life Support (ATLS), hypothermia, normothermia, and hyperthermia were defined as body temperatures of 38.1 ◦ C, respectively, upon arrival to the emergency department (ED)

  • There was no significant difference in age and comorbidities between the hypothermia and normothermia groups, except that the incidence of hypertension was significantly higher in the normothermic patients

  • More hypothermic patients were injured as the driver of a motor vehicle, the driver of a motorcycle, and as a victim in a strike injury, but less were injured in a fall compared to normothermic patients

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Summary

Introduction

Recent studies reported hypothermia to be associated with an increased injury severity [17] and a predictor of mortality in trauma patients [2,3,4,5,6,7,8,9,10,11]. The definition of hypothermia may, significantly affect the observed clinical outcomes To solve these limitations, a well-designed randomized controlled trial is needed, it is difficult to perform in trauma patients. To achieve this study goal, the present study used a PSM model to determine the effect of hypothermia defined by ATLS on in-hospital mortality of trauma patients, and to estimate the effect of body temperature on in-hospital mortality by using multivariate logistic regression

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