Accidental cold-related injury leading to hospitalization in northern Sweden: an eight-year retrospective analysis

Abstract

BackgroundCold injuries are rare but important causes of hospitalization. We aimed to identify the magnitude of cold injury hospitalization, and assess causes, associated factors and treatment routines in a subarctic region.MethodsIn this retrospective analysis of hospital records from the 4 northernmost counties in Sweden, cases from 2000-2007 were identified from the hospital registry by diagnosis codes for accidental hypothermia, frostbite, and cold-water drowning. Results were analyzed for pre-hospital site events, clinical events in-hospital, and complications observed with mild (temperature 34.9 - 32°C), moderate (31.9 - 28°C) and severe (<28°C), hypothermia as well as for frostbite and cold-water drowning.ResultsFrom the 362 cases, average annual incidences for hypothermia, frostbite, and cold-water drowning were estimated to be 3.4/100 000, 1.5/100 000, and 0.8/100 000 inhabitants, respectively. Annual frequencies for hypothermia hospitalizations increased by approximately 3 cases/year during the study period. Twenty percent of the hypothermia cases were mild, 40% moderate, and 24% severe. For 12%, the lowest documented core temperature was 35°C or higher, for 4% there was no temperature documented. Body core temperature was seldom measured in pre-hospital locations. Of 362 cold injury admissions, 17 (5%) died in hospital related to their injuries. Associated co-factors and co-morbidities included ethanol consumption, dementia, and psychiatric diagnosis.ConclusionsThe incidence of accidental hypothermia seems to be increasing in this studied sub-arctic region. Likely associated factors are recognized (ethanol intake, dementia, and psychiatric diagnosis).

Ethanol and isolated traumatic brain injury

“…A further neuroprotective mechanism may be the reduction of hyperglycolysis associated with ethanol exposure following TBI [10]. Ethanol may lead to a decrease in body temperature and this may have a neuroprotective effect [18]. Finally, ethanol decreases conscious state and, thus, patients with mild head injury may present as deeply comatose and meet the criteria for severe TBI where assessment of TBI severity is made by clinical state rather than anatomical or CT scan features.…”

Accidental hypothermia in recreational activities in the mountains: A narrative review

“…The following data refer to the general population and are not specific to sport or recreation. The estimated incidence of accidental hypothermia in the general population ranges from approximately 1‐5 cases per 100 000 inhabitants per year in European countries and 5.6 per 1 million persons per year in the USA . The annual incidence of fatal cases may be higher in rural compared to urban areas .…”

“…Thus, data reflect only those cases requiring hospitalization (or deaths) and do not account for less severe cases not requiring hospitalization or undiagnosed cases of hypothermia. Studies have shown that mild and moderate hypothermia account for a considerable proportion of all cases of hypothermia . Secondly, because data are often collected retrospectively and filtered using the International Classification of Diseases diagnosis codes, only those cases for which hypothermia is documented as such can be retrieved.…”

“…Recent studies have investigated how often core body temperature is measured by emergency medical providers when attending to cases of accidental hypothermia and whether esophageal or tympanic measurement is used, as stated by recommendations . Based on data from hospitals in Northern Sweden in the period 2000‐2007 temperature was measured pre‐hospitally in 12.3% of cases (30/244) and the body site was recorded in 7% of these cases (rectal or epitympanic) . A survey of 42 pre‐hospital medical service providers in Norway found that air ambulances and search and rescue services were better equipped to measure body temperature than ground ambulance services .…”

“…Prevention of hypothermia has first and foremost to do with adequate preparation . Hypothermia can occur even in moderate climates and although there is a peak in colder months it can occur in any month of the year . Although preparation is largely the responsibility of the athlete or recreationist, organizing bodies can also play a role in preparation and prevention in the case of organized races and outdoor events.…”