Continued Relevance of Initial Temperature Measurement in Trauma Patients

Abstract

Objectives Hypothermia occurs in 30-50% of severely injured trauma patients and is associated with multiple metabolic derangements and worsened outcomes. However, hypothermia continues to be under-diagnosed which leads to inadequate triage and treatment in trauma patients. Our study set out to determine if hypothermia is an independent predictor of mortality in trauma patients. Methods We retrospectively reviewed data of all trauma activation patients over a 5-year period. Data were collected on patient demographics, initial core temperature, Glasgow Coma Scale (GCS) on presentation, and injury severity score (ISS). Patients were then stratified into groups based on presenting temperature, ISS, and GCS. Outcomes compared were mortality, blood products received, and intensive care unit (ICU) length of stay. Correlations and logistic regression were used to test the hypotheses. Results Survival and temperature data were reviewed on 15,567 patients. Initial temperature was not significantly associated with ICU length of stay or blood products transfused ( P = .21 and P = .08, respectively). However, odds ratio of mortality in hypothermic patients (<35°C) compared to normothermic patients (35-39°C) was 3.95 (95% CI 2.90-5.41). When controlling for GCS and ISS, separately, temperature remained an independent predictor of mortality. Conclusions Hypothermia is an independent risk factor for mortality in trauma patients. It remains crucial to obtain accurate presenting temperatures in trauma patients in order to triage and treat hypothermia. Based on our data, obtaining core temperatures and rapidly treating hypothermia continues to be a vital part of the secondary survey of trauma patients.

Perioperative Considerations in Management of the Severely Bleeding Coagulopathic Patient

“…While hypothermia is sometimes used as a neuroprotective mechanism under controlled circumstances, inadvertent hypothermia is associated with dysregulation of coagulation enzymes, platelet dysfunction, fibrinolysis, endothelial injury, and worse outcomes. 118 , 119 Recent guidelines recommend early application of measures to reduce heat loss to achieve and maintain normothermia (Grade 1C) to optimize coagulation. 105 Additionally, metabolic acidosis and hypocalcemia often present in uncontrolled hemorrhage and are each associated with increased coagulopathy, transfusion requirements, and mortality.…”

American Association for the Surgery of Trauma/American College of Surgeons Committee on Trauma: Clinical protocol for damage-control resuscitation for the adult trauma patient

“…64 Hypothermia is independently associated with increased blood product needs and mortality in trauma patients, and aggressive correction mitigates this increased mortality. 65,66 Evidence-based algorithms include active rewarming for anyone with a temperature of <37°C. However, if a tourniquet is in place, warming the extremity beyond the tourniquet is not recommended.…”

“…Continuous measurement of sublingual, tympanic, or urinary bladder catheter temperature is recommended, 63 and invasive monitors (e.g., esophageal, bladder) more closely approximate core temperature (i.e., intravascular) 64 . Hypothermia is independently associated with increased blood product needs and mortality in trauma patients, and aggressive correction mitigates this increased mortality 65,66 . Evidence-based algorithms include active rewarming for anyone with a temperature of <37°C.…”

Investigation of Heating Temperatures of Infusion Solutions and Heating Effects in Cold Environments

“…This lethal triad [1] has been recognized as an important cause of death in trauma patients. In fact, numerous reports have described a relation between hypothermia and mortality in trauma patients [2][3][4][5][6]. Heat loss typically occurs at a rate of 60-75 kcal/h, but can occur at a rate of 400 kcal/h in trauma patients [7].…”