Risk factors for onset of hypothermia in trauma victims: The HypoTraum study

Abstract

IntroductionHypothermia is common in trauma victims and is associated with an increase in mortality. Its causes are not well understood. Our objective was to identify the factors influencing the onset of hypothermia during pre-hospital care of trauma victims.MethodsThis was a multicenter, prospective, open, observational study in a pre-hospital setting.The subjects were trauma victims, over 18 years old, receiving care from emergency medical services (EMS) and transported to hospital in a medically staffed mobile unit.Study variables included: demographics and morphological traits, nature and circumstances of the accident, victim's presentation (trapped, seated or lying down, on the ground, unclothed, wet or covered by a blanket), environmental conditions (wind, rain, ground temperature and air temperature on site and in the mobile unit), clinical factors, Revised Trauma Score (RTS), tympanic temperature, care provided (including warming, drugs administered, infusion fluid temperature and volume), and EMS and hospital arrival times.ResultsA total of 448 patients were included. Hypothermia (<35°C) on hospital arrival was present in 64/448 patients (14%). Significant factors associated with the absence of hypothermia in a multivariate analysis were no intubation: Odds Ratio: 4.23 (95% confidence interval 1.62 to 1.02); RTS: 1.68 (1.29 to 2.20); mobile unit temperature: 1.20 (1.04 to 1.38); infusion fluid temperature: 1.17 (1.05 to 1.30); patient not unclothed: 0.40 (0.18 to 0.90); and no head injury: 0.36 (0.16 to 0.83).ConclusionsThe key risk factor for the onset of hypothermia was the severity of injury but environmental conditions and the medical care provided by EMS were also significant factors. Changes in practice could help reduce the impact of factors such as infusion fluid temperature and mobile unit temperature.

Victims of lethal hypothermia have decreased levels of thrombomodulin in myocardium and urine

“…High urinary TM concentration (>15.5 ng/ml) was able to correctly identify 78.0 % of the CVD deaths in this study. Trauma victims are often at risk of hypothermia [28], and assessing the role of cooling in traumatic deaths can be difficult. Urinary TM could not be used here to distinguish between hypothermia and traumatic deaths, but this was achieved using immunohistochemistry.…”

Équipement des Smur pour la prise en charge préhospitalière du choc hémorragique : peut mieux faire !

“…Le contrô le de la volé mie, le choix des soluté s de remplissage et des produits sanguins labiles ainsi que la gestion de la normothermie font l'objet de recommandations pour amé liorer la survie des patients victimes d'hé morragie, notamment durant les premiè res heures de la prise en charge [4][5][6][7][8]. L'emploi de l'acide tranexamique dans les trois premiè res heures de la prise en charge d'un patient traumatisé a dé montré son efficacité sur la ré duction de la mortalité dans l'é tude multicentrique randomisé e CRASH-2 [9].…”

Systematic Review of Evidence-Based in Beneficial Preventing Hypothermia for Adult Trauma Patients in Accident.

“…Another significant factor was mobile unit temperature. In order to minimize hypothermia in trauma victims, therefore some studies have recommend that infusion fluid temperature be controlled, that small infusion volumes be used for resuscitation, that the mobile unit be heated, and that trauma victims preferably remain clothed (33,34,35) . We identified observational study (35) carried out by the mobile EMS of eight French hospitals between 1 January 2004 and 10 November 2007, that included Body temperature measurements on arrival at hospital were available for 448 patients.…”