Accidental hypothermia in Poland – estimation of prevalence, diagnostic methods and treatment

Abstract

BackgroundThe incidence of hypothermia is difficult to evaluate, and the data concerning the morbidity and mortality rates do not seem to fully represent the problem. The aim of the study was to estimate the actual prevalence of accidental hypothermia in Poland, as well as the methods of diagnosis and management procedures used in emergency rooms (ERs).MethodsA specially designed questionnaire, consisting of 14 questions, was mailed to all the 223 emergency rooms (ER) in Poland. The questions concerned the incidence, methods of diagnosis and risk factors, as well as the rewarming methods used and available measurement instruments.ResultsThe analysis involved data from 42 ERs providing emergency healthcare for the population of 5 305 000. The prevalence of accidental hypothermia may have been 5.05 cases per 100.000 residents per year. Among the 268 cases listed 25% were diagnosed with codes T68, T69 or X31, and in 75% hypothermia was neither included nor assigned a code in the final diagnosis. The most frequent cause of hypothermia was exposure to cold air alongside ethanol abuse (68%). Peripheral temperature was measured in 57%, core temperature measurement was taken in 29% of the patients. Peripheral temperature was measured most often at the axilla, while core temperature measurement was predominantly taken rectally. Mild hypothermia was diagnosed in 75.5% of the patients, moderate (32-28°C) in 16.5%, while severe hypothermia (less than 28°C) in 8% of the cases. Cardiopulmonary resuscitation was carried out in 7.5% of the patients. The treatment involved mainly warmed intravenous fluids (83.5%) and active external rewarming measures (70%). In no case was extracorporeal rewarming put to use.ConclusionsThe actual incidence of accidental hypothermia in Polish emergency departments may exceed up to four times the official data. Core temperature is taken only in one third of the patients, the treatment of hypothermic patients is rarely conducted in intensive care wards and extracorporeal rewarming techniques are not used. It may be expected that personnel education and the development of management procedures will brighten the prognosis and increase the survival rate in accidental hypothermia.

Indoor accidental hypothermia in the elderly: an emerging lethal entity in the 21st century

“…In this regard, a role model has been set by the Severe Accidental Hypothermia centre in Cracow, Poland, where low reading thermometers were promoted pre-hospitally9 and specific training for accidental hypothermia diagnosis, hospital triage and treatment was provided to pre-hospital and in-hospital staff. After taking up work, a four times higher than reported rate for accidental hypothermia was noted 10. This may imply that also in other regions worldwide accidental hypothermia may be underdiagnosed and undertreated without proper equipment and staff training.…”

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

“…The following data refer to the general population and are not specific to sport or recreation. The estimated incidence of accidental hypothermia in the general population ranges from approximately 1‐5 cases per 100 000 inhabitants per year in European countries and 5.6 per 1 million persons per year in the USA . The annual incidence of fatal cases may be higher in rural compared to urban areas .…”

Management of hypothermia — Severe Accidental Hypothermia Centre in Krakow

“…Szacuje się jednak, że liczba ta może być kilkakrotnie większa [25]. Analiza kart zgonów wystawionych w latach 2009-2012 na terenie Polski wykazała, że narażenie na nadmierne naturalne zimno było wyjściową przyczyną śmierci 1836 osób.…”

“…PODSUMOWANIE Na podstawie badania ankietowego przeprowadzonego na 50 oddziałach ratunkowych w kraju, obejmujących opieką populację ok. 4,2 mln osób, częstość występowania istotnej klinicznie hipotermii ocenia się na 6/100 000 mieszkańców/rok [25]. Warto jednak podkreślić, że w wielu regionach, zwłasz-cza tam, gdzie ryzyko hipotermii jest teoretycznie niewielkie, pomiar temperatury jest rzadko wykonywanym badaniem, a niedostatki aparatury pozwalają na ocenę jedynie temperatury powierzchniowej.…”