Association of body temperature with in-hospital mortality among paediatric trauma patients: an analysis of a nationwide observational trauma database in Japan

Okada, Asami; Okada, Yohei; Narumiya, Hiromichi; Ishii, Wataru; Kitamura, Tetsuhisa; Osamura, Toshio; Iiduka, Ryoji

doi:10.1136/bmjopen-2019-033822

Cited by 3 publications

(2 citation statements)

References 36 publications

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“…Temperatures were recorded from the ear, rectum, urinary bladder, axilla, and others. The patients were categorized into three groups according to their temperature on arrival at the hospital, based on clinical significance according to previous studies [ 7 , 12 ]. The low BT group had an initial temperature of 35.9 °C or below; the normothermia group was defined as the group with a temperature from 36.0 °C to 36.9 °C, and the other group was the higher temperature group defined as the temperature of ≥37.0 °C.…”

Section: Methodsmentioning

confidence: 99%

Association between initial body temperature on hospital arrival and neurological outcome among patients with out-of-hospital cardiac arrest: a multicenter cohort study (the CRITICAL study in Osaka, Japan)

et al. 2022

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Background The association between spontaneous initial body temperature on hospital arrival and neurological outcomes has not been sufficiently studied in patients after out-of-hospital cardiac arrest (OHCA). Methods From the prospective database of the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan, we enrolled all patients with OHCA of medical origin aged > 18 years for whom resuscitation was attempted and who were transported to participating hospitals between 2012 and 2019. We excluded patients who were not witnessed by bystanders and treated by a doctor car or helicopter, which is a car/helicopter with a physician. The patients were categorized into three groups according to their temperature on hospital arrival: ≤35.9 °C, 36.0–36.9 °C (normothermia), and ≥ 37.0 °C. The primary outcome was 1-month survival, with a cerebral performance category of 1 or 2. Multivariable logistic regression analyses were performed to evaluate the association between temperature and outcomes (normothermia was used as the reference). We also assessed this association using cubic spline regression analysis. Results Of the 18,379 patients in our database, 5014 witnessed adult OHCA patients of medical origin from 16 hospitals were included. When analyzing 3318 patients, OHCA patients with an initial body temperature of ≥37.0 °C upon hospital arrival were associated with decreased favorable neurological outcomes (6.6% [19/286] odds ratio, 0.51; 95% confidence interval, 0.27–0.95) compared to patients with normothermia (16.4% [180/1100]), whereas those with an initial body temperature of ≤35.9 °C were not associated with decreased favorable neurological outcomes (11.1% [214/1932]; odds ratio, 0.78; 95% confidence interval, 0.56–1.07). The cubic regression splines demonstrated that a higher body temperature on arrival was associated with decreased favorable neurological outcomes, and a lower body temperature was not associated with decreased favorable neurological outcomes. Conclusions In adult patients with OHCA of medical origin, a higher body temperature on arrival was associated with decreased favorable neurologic outcomes.

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Section: Methodsmentioning

confidence: 99%

Association between initial body temperature on hospital arrival and neurological outcome among patients with out-of-hospital cardiac arrest: a multicenter cohort study (the CRITICAL study in Osaka, Japan)

et al. 2022

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“…31 Although the effect of hypothermia maybe due to increased blood loss and blood product utilization, this recent study and several other studies suggest that hypothermia may be an independent factor that contributes to both early and late mortality. [31][32][33][34][35] However, some degree of hypothermia is protective for conditions of ischemia/reperfusion, such as been demonstrated most commonly following cardiac arrest and during cardiopulmonary surgery. 36 37 Thus, this raises the question of if and why hypothermia following injury may be associated with poor outcome and late mortality, compared with other ischemia/reperfusion conditions.…”

Section: Introductionmentioning

confidence: 99%

Chronic critical illness after hypothermia in trauma patients

Miranda

Maine

Cook

et al. 2021

Trauma Surg Acute Care Open

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ObjectivesChronic critical illness (CCI) is a phenotype that occurs frequently in patients with severe injury. Previous work has suggested that inflammatory changes leading to CCI occur early following injury. However, the modifiable factors associated with CCI are unknown. We hypothesized that hypothermia, an early modifiable factor, is associated with CCI.MethodsTo determine the association of hypothermia and CCI, a secondary analysis of the Inflammation and Host Response to Injury database was performed, and subsequently validated on a similar cohort of patients from a single level 1 trauma center from January 2015 to December 2019. Hypothermia was defined as initial body temperature ≤34.5°C. CCI was defined as death or sustained multiorgan failure ≥14 days after injury. Data were analyzed using univariable analyses with Student’s t-test and Pearson’s χ2 test, and logistic regression. An arrayed genomic analysis of the transcriptome of circulating immune cells was performed in these patients.ResultsOf the initial 1675 patients, 254 had hypothermia and 1421 did not. On univariable analysis, 120/254 (47.2%) of patients with hypothermia had CCI, compared with 520/1421 (36.6%) without hypothermia who had CCI, p<0.001. On multivariable logistic regression, hypothermia was independently associated with CCI, OR 1.61 (95% CI 1.17 to 2.21) but not mortality. Subsequent validation in 1264 patients of which 172 (13.6%) were hypothermic, verified that hypothermia was independently associated with CCI on multivariable logistic regression, OR 1.84 (95% CI 1.21 to 2.41). Transcriptomic analysis in hypothermic and non-hypothermic patients revealed unique cellular-specific genomic changes to only circulating monocytes, without any distinct effect on neutrophils or lymphocytes.ConclusionsHypothermia is associated with the development of CCI in severely injured patients. There are transcriptomic changes which indicate that the changes induced by hypothermia may be associated with persistent CCI. Thus, early reversal of hypothermia following injury may prevent the CCI.Level of evidenceIII.

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Associations Between Core Temperature Disorders and Outcomes of Pediatric Intensive Care Unit Patients

Kiekkas,

Kourtis,

Feizidou

et al. 2023

American Journal of Critical Care

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Background The few studies of associations between fever and outcomes in pediatric intensive care unit (PICU) patients have conflicting findings. Associations between hypothermia and patient outcomes have not been studied. Objective To investigate the incidence and characteristics of fever and hypothermia and their associations with adverse outcomes among PICU patients. Methods Patients consecutively admitted to 2 PICUs in a 2-year period were prospectively studied. Core temperature was mainly measured by rectal or axillary thermometry. Fever and hypothermia were defined as core temperatures of greater than 38.0 °C and less than 36.0 °C, respectively. Prolonged mechanical ventilation, prolonged PICU stay, and PICU mortality were the adverse patient outcomes studied. Associations between patient outcomes and core temperature disorders were evaluated with univariate comparisons and multivariate analyses. Results Of 545 patients enrolled, fever occurred in 299 (54.9%) and hypothermia occurred in 161 (29.5%). Both temperature disorders were independently associated with prolonged mechanical ventilation and prolonged PICU stay (P < .001) but not with PICU mortality. Late onset of fever (P < .001) and hypothermia (P = .009) were independently associated with prolonged mechanical ventilation, fever magnitude and duration (both P < .001) were independently associated with prolonged PICU stay, and fever magnitude (P < .001) and infectious cause of hypothermia (P= .01) were independently associated with higher PICU mortality. Conclusions These findings provide evidence that the manifestation and characteristics of fever and hypothermia are independent predictors of adverse outcomes in PICU patients.

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Association of body temperature with in-hospital mortality among paediatric trauma patients: an analysis of a nationwide observational trauma database in Japan

Cited by 3 publications

References 36 publications

Association between initial body temperature on hospital arrival and neurological outcome among patients with out-of-hospital cardiac arrest: a multicenter cohort study (the CRITICAL study in Osaka, Japan)

Association between initial body temperature on hospital arrival and neurological outcome among patients with out-of-hospital cardiac arrest: a multicenter cohort study (the CRITICAL study in Osaka, Japan)

Chronic critical illness after hypothermia in trauma patients

Associations Between Core Temperature Disorders and Outcomes of Pediatric Intensive Care Unit Patients

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