NEW YORK (Reuters Health) – Accidental hypothermia is common after major trauma and more than triples the risk of death, researchers from Australia report in the November 12th online issue of Resuscitation.

“The main message not only for physicians, but for all health professionals working in this area of practice is the need to recognize the seriousness of accidental hypothermia in major trauma victims and proactively implement heat-loss preventative strategies and begin to re-warm those patients with identified hypothermia as a matter of priority,” Dr. Sharyn Ireland from Alfred Health and La Trobe University, Melbourne, Victoria, Australia told Reuters Health in an email.

Dr. Ireland and colleagues investigated the incidence of accidental hypothermia in 732 adult major trauma patients and compared outcomes of patients with and without hypothermia.

“Living and working in Australia, we were surprised when we first began looking at this work some 5 years ago now,” Dr. Ireland said. “Retrospective data from the Trauma Registry, Alfred Health, demonstrated a high incidence of accidental hypothermia in our major trauma patients.”

“After two previous studies, that investigated staff knowledge about hypothermia in major trauma, and implementing a clinical practice guideline to improve the monitoring and management of hypothermia, we were better positioned to prospectively investigate the incidence of this problem for our major trauma patients,” Dr. Ireland explained.

Ninety-seven patients (13.25%) had hypothermia on arrival to the emergency and trauma center, and 88 of these had been referred directly from the scene of the injury.

In multivariate logistic regression analysis, hypothermia was independently associated with a 3.44-fold increased risk of death. Other factors independently increasing the risk of death were prehospital intubation, major burn injury, falls, older age, coagulopathy, and higher injury severity score.

Prehospital intubation, winter season, and lower arrival systolic blood pressure were independently associated with an increased risk for hypothermia, whereas motorbike accident, higher arrival respiratory rate, and falls were associated with a lower risk for hypothermia.

“Following on from this study, we recognize that to make a difference on arrival temperature for hypothermic major trauma patients, preventative heat-loss and re-warming strategies should commence in the pre-hospital setting, as soon as it is practical from the time of injury,” Dr. Ireland said. “We are planning to investigate preventative heat-loss strategies and re-warming strategies with pre-hospital providers.”

Dr. Ireland added, “Temperature should be recorded as part of the initial primary survey for these patients and efforts of re-warming must be monitored by way of recording repeat temperatures if any improvement is to be realized. Patients who are cold are extremely difficult to re-warm and it is therefore imperative that minimizing exposure, keeping the patient covered with warm blankets and the administration of warmed intravenous fluid is commenced early and maintained. In addition, forced air warming should be implemented for all patients identified with accidental hypothermia. Early transfer to a level 1 Trauma facility for major trauma patients is another priority.”

Reference:

The incidence and significance of accidental hypothermia in major trauma—A prospective observational study

Resuscitation 12 November 2010.