Hypothermia in trauma victims at first arrival of ambulance personnel: an observational study with assessment of risk factors

Abstract

BackgroundHypothermia is common in trauma victims and is associated with increased mortality, however its causes are little known. The objective of this study was to identify the risk factors associated with hypothermia in prehospital management of trauma victims.MethodsThis was an ancillary analysis of data recorded in the HypoTraum study, a prospective multicenter study conducted by the emergency medical services (EMS) of 8 hospitals in France. Inclusion criteria were: trauma victim, age over 18 years, and victim receiving prehospital care from an EMS team and transported to hospital by the EMS team in a medically equipped mobile intensive care unit. The following data were recorded: victim demographics, circumstances of the trauma, environmental factors, patient presentation, clinical data and time from accident to EMS arrival. Independent risk factors for hypothermia were analyzed in a multivariate logistic regression model.ResultsA total of 461 trauma patients were included in the study. Road traffic accidents (N = 261; 57%) and falls (N = 65; 14%) were the main causes of trauma. Hypothermia (<35 °C) was present in 136/461 cases (29%). Independent factors significantly associated with the presence of hypothermia were: a low GCS (Odds Ratio (OR) = 0,87 ([0,81-0,92]; p < 0.0001), a low air temperature (OR = 0,93 [0,91-0,96]; p < 0.0001) and a wet patient (OR = 2,08 [1,08-4,00]; p = 0.03).ConclusionThe incidence of hypothermia was high on EMS arrival at the scene. Body temperature measurement and immediate thermal protection should be routine, and special attention should be given to patients who are wet.Level of evidenceProspective, multicenter, open, observational study; Level IV.

Forced-air-warming for hypothermia prevention in entrapment after road traffic collisions

“…Environmental factors can aggravate the inevitable heat loss and especially entrapped patients in austere environments undergoing prolonged extrication can suffer severe hypothermia [8]. Even though there is some evidence regarding hypothermia mitigation during hospital transport, there is no literature on hypothermia prevention in patients that are still entrapped [9].…”

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

“…In addition, it is not always specified whether hypothermia was the primary injury (eg, from cold air or water exposure) or developed secondary to another illness (eg, trauma). Many articles focus exclusively on hypothermia resulting secondary to severe trauma because of the high incidence and poor prognosis of these cases …”

“…Many articles focus exclusively on hypothermia resulting secondary to severe trauma because of the high incidence and poor prognosis of these cases. 56 For these reasons, it is difficult based on existing data to differentiate cases of hypothermia that are directly due to cold exposure during recreation. It is possible that a higher proportion of cases occurring in rural areas is due to exposure during recreation compared to urban areas.…”

When do trauma patients lose temperature? – a prospective observational study

“…[1][2][3][4] Mortality and the prevalence of hypothermia increases with the severity of injury and thus also with a higher injury severity score (ISS). 5 Lapostolle et al 6,7 found that the key risk factors of hypothermia were severity of injury, environmental conditions, and provided medical care.…”

“…[8][9][10][11][12] A pre-hospital, multicenter observational study from 2016 found that hypothermia (< 35°C) was present in 29 % of all trauma patients on arrival of emergency medical services (EMS). 7 Hypothermia develops in trauma patients for a number of reasons, including cold exposure at the scene of injury, during primary and secondary survey, administration of cold intravenous fluids and transfusion products, and heat loss from open body cavities due to injury or during surgery. Rapid detection and correction of hypothermia is therefore crucial in these patients, as the important coagulation processes to reduce blood loss are less effective with increasing degree of hypothermia.…”