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Effect of Hypothermia in the Emergency Department on the Outcome of Trauma Patients: A Cross-Sectional Analysis

Author

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  • Ting-Min Hsieh

    (Division of Trauma Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Song District, Kaohsiung 833, Taiwan)

  • Pao-Jen Kuo

    (Division of Plastic Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Song District, Kaohsiung 833, Taiwan)

  • Shiun-Yuan Hsu

    (Division of Plastic Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Song District, Kaohsiung 833, Taiwan)

  • Peng-Chen Chien

    (Division of Plastic Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Song District, Kaohsiung 833, Taiwan)

  • Hsiao-Yun Hsieh

    (Division of Plastic Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Song District, Kaohsiung 833, Taiwan)

  • Ching-Hua Hsieh

    (Division of Plastic Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao-Song District, Kaohsiung 833, Taiwan)

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.

Suggested Citation

  • Ting-Min Hsieh & Pao-Jen Kuo & Shiun-Yuan Hsu & Peng-Chen Chien & Hsiao-Yun Hsieh & Ching-Hua Hsieh, 2018. "Effect of Hypothermia in the Emergency Department on the Outcome of Trauma Patients: A Cross-Sectional Analysis," IJERPH, MDPI, vol. 15(8), pages 1-11, August.
  • Handle: RePEc:gam:jijerp:v:15:y:2018:i:8:p:1769-:d:164195
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    References listed on IDEAS

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    1. Chun-Ying Huang & Cheng-Shyuan Rau & Jung-Fang Chuang & Pao-Jen Kuo & Shiun-Yuan Hsu & Yi-Chun Chen & Hsiao-Yun Hsieh & Ching-Hua Hsieh, 2016. "Characteristics and Outcomes of Patients Injured in Road Traffic Crashes and Transported by Emergency Medical Services," IJERPH, MDPI, vol. 13(2), pages 1-12, February.
    2. Wei-Hung Lai & Cheng-Shyuan Rau & Shiun-Yuan Hsu & Shao-Chun Wu & Pao-Jen Kuo & Hsiao-Yun Hsieh & Yi-Chun Chen & Ching-Hua Hsieh, 2016. "Using the Reverse Shock Index at the Injury Scene and in the Emergency Department to Identify High-Risk Patients: A Cross-Sectional Retrospective Study," IJERPH, MDPI, vol. 13(4), pages 1-12, March.
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