Elsevier

Injury

Volume 29, Issue 8, October 1998, Pages 605-608
Injury

Hypothermia in critically ill trauma patients

https://doi.org/10.1016/S0020-1383(98)00139-9Get rights and content

Abstract

Objective: To determine the incidence and mortality of hypothermia in trauma patients. Methods: Retrospective review of patients admitted to the Surgical Intensive Care Unit (SICU) over 4 1/2 years. Hypothermia was defined as a temperature <35°C. Results: There were 7045 admissions to the SICU, of which 661 (9.4%) had a recorded temperature of <35°C. Over half (395) were trauma patients, with a mortality of 52.7%. The temperature ranged from 27.1 to 34.9°C, with a mean for survivors of 34.0°C and 33.1°C for those that died. There was a significant difference in Apache II scores (16.6 vs 25.4) and Injury Severity Scores (26.1 vs 33.4) between survivors and non-survivors. Conclusions: The incidence of hypothermia in trauma patients is significant and is independent of the month of admission. Mortality is high but there is no threshold below which mortality is assured. Unlike historical data, 13 patients survived temperatures <32°C.

Introduction

Hypothermia has been reported to be a valuable adjunct in cardiothoracic surgery and neurosurgery. However, in trauma patients, hypothermia has been noted to have detrimental effects with a mortality as high as 100% for temperatures below 32°C[1]. We recently noted several survivors with temperatures below this range but also noted a disturbingly high incidence at a time of year when awareness is low. We reviewed all admissions to the Surgical Intensive Care Unit (SICU) to determine which patient populations are affected most, the incidence over time, and the mortality.

Section snippets

Materials and methods

Using the SICU database, a retrospective review of all trauma patients admitted to the SICU over 41/2 years was performed. The worst temperature within the first 24 h as classified by the APACHE II score2, 3was noted. Hypothermia was defined as a temperature <35°C. Demographics including age, gender, month of admission, SICU and hospital length of stay, APACHE II score, injury severity score (ISS)[4], and mortality were noted. Statistical analysis was done using Student's t-test to compare the

Results

There were 7,045 admissions to the SICU over 41/2 years. Only 661 (9.4%) had a recorded temperature <35°C. Most of the patients (395, 59.8%) were trauma patients. Demographics of the trauma patients are shown in Table 1. Many of these patients had a neurological deficit (58, 14.6%). This represents nearly one third of all patients with a neurologic deficit admitted to the SICU during this time (29.1%). The mortality in this group of patients was 32.8%. The temperature for the trauma patients

Discussion

At least three separate studies have shown an increased risk of death with hypothermia in trauma patients1, 5, 6. When matched for injury severity, this increased mortality was independent of hypotension, fluid requirements, age, or duration of surgery[7]. The reason for this increased mortality is unclear, particularly when hypothermia has been reported to be beneficial under other circumstances. Perhaps the detrimental effects are particularly harmful in the trauma patient with a preexisting

Conclusion

The incidence of hypothermia in trauma patients is significant and is independent of the month of admission. Mortality is high but there is no threshold below which mortality is assured. Unlike historical data, 13 patients survived temperatures <32°C.

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