Hypothermia in trauma patients arriving at an emergency department by ambulance in Johannesburg, South Africa: a prospective study

Abstract

Introduction Normal body temperature is considered to be between 36 and 38°C. Temperatures that are too low may negatively affect physiological functions. In trauma cases, factors that promote the development of hypothermia include concomitant hypoxia, hypotension, decreased levels of consciousness, contact with cold surfaces, exposure to low ambient temperatures and the administration of cold fluids. Studies on emergency department related hypothermia in Africa are sparse. This study investigated instances of hypothermia in a sample of trauma cases arriving by ambulance to an emergency department in Johannesburg, South Africa. Methods Core body temperatures of 140 trauma cases were measured upon arrival and 30 minutes later. Ambient temperatures outside the hospital, inside the ED and in the resuscitation areas were also recorded. Additional information was gathered describing the equipment available to the ambulance crews for temperature, control and rewarming. Results Seventy-two (51%) of the cases were found to have core body temperatures less than 36°C upon arrival. Twenty-nine (21%) the cases were considered clinically hypothermic (core temperatures of less than <35°C). After 30 minutes, 79 (56%) of the participants had core body temperatures of less than 36°C and 39 (28%) remained lower than 35°C. Patients were not warming up in the ED as expected. Rather, some had become colder. The study also found that the ambient temperature in the triage area fluctuated and was recorded as less than the recommended 21°C in 95 (68%) of the cases. In addition, the majority of ambulances that transported these cases lacked appropriate equipment on board to properly facilitate temperature control and rewarming. Conclusion Fifty-one percent of the trauma cases arriving by ambulance had core temperature <36°C. Many became even colder in the ED. Attention needs to be given to the early identification of hypothermia, the regulation of ambient temperatures inside the ED including the provision of appropriate heating and rewarming devices on ambulances.

Accidental hypothermia and related risk factors among trauma patients in prehospital setting

“…Our findings were supported by several studies. They demonstrated that ambient temperature can act as an independent predictor of hypothermia among trauma patients in various clinical settings [19][20][21][22][23]. Additionally, certain research [3,24] has indicated that ambient temperature is an independent determinant in the occurrence of accidental hypothermia in trauma patients in emergency departments and operating rooms.…”

Trauma Prehospital Hypothermia Prevention and Treatment: An Observational Study

“…These findings are in accordance with other studies that did not find any evidence of the effectiveness of the use of heaters to warm up the environment (Alex, Lundgren, Henriksson, & Saveman, 2013; Giannoudi & Harwood, 2016; Gill & Cox, 2008). Most ambulances do not have the right equipment to facilitate temperature control and reheating (Vincent-Lambert, Smith, & Goldstein, 2018). Nevertheless, and despite the lack of evidence regarding its effectiveness in raising the temperature, when administered alone, this measure should be used as an adjunct when dealing with a patient with hypothermia for the first time (Giannoudi & Harwood, 2016; Henriksson et al, 2012; Lundgren et al, 2011).…”

Development of Body Temperature and Its Influence on the Overall Outcome in Critically Ill Patients in the Emergency Department

“…median values, on the contrary, they showed an increasing trend. The evolution of body temperature in trauma patients was also investigated by Vincent-Lambert et al (3). The study aimed to analyze body temperature in trauma patients brought to the emergency department.…”

“…Hypothermia is part of the so-called lethal triad in this condition. The importance of thermal comfort was recognized by the authors of the study by Vincent-Lambert et al (3), who investigated hypothermia in trauma patients brought to the emergency department by the ambulance service. A second, relatively frequent, serious condition that occurs in the emergency department is stroke.…”