Injury · 2024
Hypothermia on admission predicts poor outcomes in adult trauma patients.
СтатьяНазвание и аннотация: Перевод в очереди
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Jose Anna Mary, Rafieezadeh Aryan, Zeeshan Muhammad, Kirsch Jordan, Froula Gabriel, Prabhakaran Kartik, Zangbar Bardiya
Аннотация
BACKGROUND: Hypothermia is known to contribute to poor outcomes in trauma patients during acute phases. The aim of our study is to evaluate the effect of hypothermia on admission, upon in-hospital complications and mortality in adult trauma patients.
METHODS: We performed a 5-year analysis of ACS-TQIP database (2017-2021). Patients with incomplete data, burns, inter-facility transfers, or documented as dead on arrival were excluded. Hypothermia (HT) was defined as a temperature of <35 degrees Celsius (°C), and Normothermia (NT) as ≥35 °C to≤40 °C measured at the time of patient arrival. Data were collected including demographic variables, mechanism of injury, injury severity, injury patterns, and shock index. Outcome variables were mortality, ICU length of stay (LOS), duration of mechanical ventilation, hospital LOS, and in-hospital complications. Multivariable regression analysis was performed.
RESULTS: A total of 3,043,030 patients were included and 1 % were hypothermic. HT patients were severely injured, developed in-hospital complications (17.1 %vs.4.5 %), had longer ICU LOS (4 (2-9) vs. 3 (2-5) days), hospital LOS (5 (2-12) vs. 4 (2-6) days), and higher mortality (23.4 % vs. 2.3 %). Hypothermia was independently associated with higher odds of mortality (OR:1.934 [1.858-2.013]). Subgroup analysis of patients with isolated traumatic brain injury revealed pre-hospital hypothermia to still be an independent predictor of mortality (OR: 1.728[1.600-1.867]). HT who underwent rewarming had a lower mortality, shorter hospital and ICU LOS.
CONCLUSION: Pre-hospital hypothermia is independently associated with higher resource utilization, in-hospital complications, and mortality. Even in patients with isolated TBI, pre-hospital hypothermia increases the odds of mortality. Rewarming interventions can potentially improve outcomes among patients, even with mild hypothermia.
LEVEL OF EVIDENCE: Level III retrospective study.
METHODS: We performed a 5-year analysis of ACS-TQIP database (2017-2021). Patients with incomplete data, burns, inter-facility transfers, or documented as dead on arrival were excluded. Hypothermia (HT) was defined as a temperature of <35 degrees Celsius (°C), and Normothermia (NT) as ≥35 °C to≤40 °C measured at the time of patient arrival. Data were collected including demographic variables, mechanism of injury, injury severity, injury patterns, and shock index. Outcome variables were mortality, ICU length of stay (LOS), duration of mechanical ventilation, hospital LOS, and in-hospital complications. Multivariable regression analysis was performed.
RESULTS: A total of 3,043,030 patients were included and 1 % were hypothermic. HT patients were severely injured, developed in-hospital complications (17.1 %vs.4.5 %), had longer ICU LOS (4 (2-9) vs. 3 (2-5) days), hospital LOS (5 (2-12) vs. 4 (2-6) days), and higher mortality (23.4 % vs. 2.3 %). Hypothermia was independently associated with higher odds of mortality (OR:1.934 [1.858-2.013]). Subgroup analysis of patients with isolated traumatic brain injury revealed pre-hospital hypothermia to still be an independent predictor of mortality (OR: 1.728[1.600-1.867]). HT who underwent rewarming had a lower mortality, shorter hospital and ICU LOS.
CONCLUSION: Pre-hospital hypothermia is independently associated with higher resource utilization, in-hospital complications, and mortality. Even in patients with isolated TBI, pre-hospital hypothermia increases the odds of mortality. Rewarming interventions can potentially improve outcomes among patients, even with mild hypothermia.
LEVEL OF EVIDENCE: Level III retrospective study.