Pre-Hospital Hypothermia is Not Associated with Increased Survival After Traumatic Brain Injury

Bukur, Marko; Kurtovic, Silvia; Berry, Cherisse; Tanios, Mina; Ley, Eric J.; Salim, Ali

doi:10.1016/j.jss.2011.07.003

Cited by 24 publications

(35 citation statements)

References 60 publications

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“…Similarly, a retrospective cohort study based on the Los Angeles Trauma Database observed that in moderate to severe TBI, there was an association between prehospital hypothermia and mortality; however and in contrast to this study, the number of patients with hypothermia was small (n = 44) which decreased the validity of the observed result [30]. Our result is also in line with the meta-analysis of McHugh et al [15].…”

Section: Discussionsupporting

confidence: 79%

Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study

Tohme

Delhumeau

Zuercher

et al. 2014

Scand J Trauma Resusc Emerg Med

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BackgroundSevere traumatic brain injury (TBI) is a significant health concern and a major burden for society. The period between trauma event and hospital admission in an emergency department (ED) could be a determinant for secondary brain injury and early survival. The aim was to investigate the relationship between prehospital factors associated with secondary brain injury (arterial hypotension, hypoxemia, hypothermia) and the outcomes of mortality and impaired consciousness of survivors at 14 days.MethodsA multicenter, prospective cohort study was performed in dedicated trauma centres of Switzerland. Adults with severe TBI (Abbreviated Injury Scale score of head region (HAIS) >3) were included. Main outcome measures were death and impaired consciousness (Glasgow Coma Scale (GCS) ≤13) at 14 days. The associations between risk factors and outcome were assessed with univariate and multivariate regression models.Results589 patients were included, median age was 55 years (IQR 33, 70). The median GCS in ED was 4 (IQR 3-14), with abnormal pupil reaction in 167 patients (29.2%). Median ISS was 25 (IQR 21, 34). Three hundred seven patients sustained their TBI from falls (52.1%) and 190 from a road traffic accidents (32.3%). Median time from Out-of-hospital Emergency Medical Service (OHEMS) departure on scene to arrival in ED was 50 minutes (IQR 37-72); 451 patients had a direct admission (76.6%). Prehospital hypotension was observed in 24 (4.1%) patients, hypoxemia in 73 (12.6%) patients and hypothermia in 146 (24.8%). Prehospital hypotension and hypothermia (apart of age and trauma severity) was associated with mortality. Prehospital hypoxemia (apart of trauma severity) was associated with impaired consciousness; indirect admission was a protective factor.ConclusionMortality and impaired consciousness at 14 days do not have the same prehospital risk factors; prehospital hypotension and hypothermia is associated with mortality, and prehospital hypoxemia with impaired consciousness.

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Section: Discussionsupporting

confidence: 79%

Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study

Tohme

Delhumeau

Zuercher

et al. 2014

Scand J Trauma Resusc Emerg Med

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“…Bukur (2012) examined the relationship between admission HT and mortality in patients with moderate to severe TBI and found that admission HT was independently associated with increased mortality in moderate to severe TBI. Similarly, Konstantinidis (2011) sought to identify the influence of admission HT on outcome in patients with isolated severe TBI.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of the Effects of Body Temperature on Outcome After Adult Traumatic Brain Injury

Madden

DeVon

2015

Journal of Neuroscience Nursing

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Objective This systematic review describes effects of body temperature alterations defined as fever, controlled normothermia, and spontaneous or induced hypothermia on outcome following traumatic brain injury (TBI) in adults. Data sources A search was conducted using PubMed, Cochrane Library database, CINAHL, EMBASE, and ISI Web of Science in July 2013 with no back date restriction except for induced hypothermia (2009). Study selection Of 1366 titles identified, 712 were reviewed. Sixteen articles met inclusion criteria: Randomized Controlled Trials (RCT) in hypothermia since 2009 (last Cochrane review) or cohort studies of temperature in TBI; measure core and/or brain temperature; neurologic outcome reporting; primarily adult patients, and English language publications. Exclusion criteria: majority of patients were non-TBI, primarily pediatric patients, case reports, or lab/animal studies. Data synthesis The majority of studies found that fever avoidance resulted in positive outcomes including: decreased intensive care unit length of stay, mortality; and incidence of hypertension, elevated intracranial pressure, and tachycardia. Hypothermia on admission correlated with poor outcomes. Controlled normothermia improved surrogate outcomes. Prophylactic induced hypothermia is not supported by the available evidence from RCT. Conclusion Setting a goal of normothermia, avoiding fever, and aggressively treating fever may be most important after TBI. Further research is needed to: characterize the magnitude and duration of temperature alteration after TBI; determine if temperature alteration influences or predicts neurologic outcome; determine if rate of temperature change influences or predicts neurologic outcome; and compare controlled normothermia versus standard practice or hypothermia.

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“…1-9 Moreover, an association between higher baseline BT and lower presenting severity has also been reported in traumatic brain injury (TBI) and subarachnoid hemorrhage, which are not associated with thrombotic occlusions and their lysis. 24, 25 Accordingly, additional mechanisms must be considered to explain the inverse relationship between early BT measures and presenting stroke severity.…”

Section: Discussionmentioning

confidence: 99%

“…24, 26, 27 Autonomic dysfunction, such as sympathetic hyperactivity immediately after stroke onset may lower the hypothalamic thermoregulatory set-point through increased catecholamine activity in the hypothalamus. 28, 29 Like other physiologic variables, BT is apt to change according to alterations in physical conditions and the environment.…”

Section: Discussionmentioning

confidence: 99%

Initial Body Temperature in Ischemic Stroke

Kim

Saver

2015

Stroke

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Background and Purpose Body temperature (BT) is an important physiologic factor in acute ischemic stroke. However, the relation of initial BT to stroke severity and degree of benefit from thrombolytic therapy has been incompletely delineated. Methods We analyzed the public data set of the two National Institute of Neurological Disorders and Stroke tissue plaminogen activator (TPA) stroke trials, comparing patients with lower (<37.0°C) and higher (≥37.0°C) presenting BT. Results Among 595 patients (297 placebo- and 298 tPA-treated) with documented initial BT, 77.1% had initial BT <37.0°C and 22.9% ≥37.0°C. Patients with higher initial BT had lower baseline stroke severity in both tPA-treated patients (the National Institute of Health Stroke Scale median, 11 versus 15; p = 0.05) and placebo-treated patients (median, 13 versus 16; p <0.01). Patients with higher initial BT also had lower infarction volume on CT at 3 months in both tPA-treated patients (median, 9.6 versus 16.7 cm3; p = 0.08) and placebo-treated patients (median, 13.1 versus 28.1 cm3; p = 0.02), but no clinical outcome differences. Analysis of lytic treatment effect found no heterogeneity in the degree of tPA benefit in both higher and lower BT groups (≥37.0°C: odds ratio [OR] for the modified Rankin Scale 0-1 outcome 2.55, 95% confidence interval [CI] 1.05-6.21; <37.0°C: OR 2.30, 95% CI 1.38-3.84; heterogeneity p = 0.83). Conclusions In hyperacute stroke patients, higher presenting temperatures are associated with less severe neurological deficits and reduced final infarct volumes. Presenting temperature does not modify the benefit of tPA on 3-month favorable outcome. Clinical Trial Registration This trial was not registered because enrollment began prior to July 1, 2005.

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Pre-Hospital Hypothermia is Not Associated with Increased Survival After Traumatic Brain Injury

Cited by 24 publications

References 60 publications

Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study

Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study

A Systematic Review of the Effects of Body Temperature on Outcome After Adult Traumatic Brain Injury

Initial Body Temperature in Ischemic Stroke

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