Prevalence and outcomes of accidental hypothermia among elderly patients in Japan: Data from the J‐Point registry

Morita, Sachiko; Matsuyama, Tasuku; Ehara, Naoki; Miyamae, Nobuhiro; Okada, Yohei; Jo, Takaaki; Sumida, Yorihisa; Okada, Nobunaga; Watanabe, Makoto; Nozawa, Masahiro; Tsuruoka, Ayumu; Fujimoto, Yoshihiro; Okumura, Yasuko; Kitamura, Tetsuhisa; Hayashi, Yasuyuki

doi:10.1111/ggi.13502

Cited by 13 publications

(25 citation statements)

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“…Furthermore, some of the accidental hypothermia patients require invasive rewarming techniques, such as extracorporeal membrane oxygenation for hemodynamic support [ 1 – 3 ]. On the other hand, in a super-aging society such as Japan, most cases of accidental hypothermia occur in residential settings, and the patients are older, frail, and face difficulties in independent living [ 2 – 5 ]. Some patients in such a population might wish the withdrawal of ICU admission and invasive treatment for avoiding undesirable life-sustaining therapy.…”

Section: Introductionmentioning

confidence: 99%

External validation of 5A score model for predicting in-hospital mortality among the accidental hypothermia patients: JAAM-Hypothermia study 2018–2019 secondary analysis

et al. 2022

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Background The 5A score including five components “Age, Activities of daily living, Arrest, Acidemia and Albumin” was developed as an easy-to-use screening tool for predicting in-hospital mortality among patients with accidental hypothermia. However, the external validity of the 5A score has not yet been evaluated. We aimed to perform an external validation of the 5A score model. Method This secondary analysis of the multicenter, prospective cohort Japanese Association for Acute Medicine-Hypothermia Study (2018–2019), which was conducted at 87 and 89 institutions throughout Japan, collected data from December 2018 to February 2019 and from December 2019 to February 2020. Adult accidental hypothermia patients whose body temperature was 35 °C or less were included in this analysis. The probability of in-hospital mortality was calculated using a logistic regression model of the 5A score. The albumin was not recorded in this database; thus, it was imputed by estimation. Predictions were compared with actual observations to evaluate the calibration of the model. Furthermore, decision-curve analysis was used to evaluate the clinical usefulness. Results Of the 1363 patients registered in the database, data of 1139 accidental hypothermia patients were included for analysis. The median [interquartile range] age was 79 [68–87] years, and there were 625 men (54.9%) in the study cohort. The predicted probability and actual observation by risk groups produced the following results: low 7% (5.4–8.6), mild 19.1% (17.4–20.8), moderate 33.2% (29.9–36.5), and high 61.9% (55.9–67.9) predicted risks, and the low 12.4% (60/483), mild 17.7% (59/334), moderate 32.6% (63/193), and high 69% (89/129) observed mortality. These results indicated that the model was well calibrated. Decision-curve analysis visually indicated the clinical utility of the 5A score model. Conclusion This study indicated that the 5A score model using estimated albumin value has external validity in a completely different dataset from that used for the 5A model development. The 5A score is potentially helpful to predict the mortality risk and may be one of the valuable information for discussing the treatment strategy with patients and their family members.

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Section: Introductionmentioning

confidence: 99%

External validation of 5A score model for predicting in-hospital mortality among the accidental hypothermia patients: JAAM-Hypothermia study 2018–2019 secondary analysis

et al. 2022

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“…We found only 21 avalanche victims, who were the youngest group but the group with the highest mortality. Only the already mentioned study from the Netherlands and two recent studies from Japan discussed the issue of elderly people who suffered from accidental hypothermia [ 15 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Accidental Hypothermia in a Swiss Alpine Trauma Centre—Not an Alpine Problem

Habegger

Brechbühler

Vogt

et al. 2022

IJERPH

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Background: Research in accidental hypothermia focuses on trauma patients, patients exposed to cold environments or patients after drowning but rarely on hypothermia in combination with intoxications or on medical or neurological issues. The aim of this retrospective single-centre cohort study was to define the aetiologies, severity and relative incidences of accidental hypothermia, methods of measuring temperature and in-hospital mortality. Methods: The study included patients ≥18 years with a documented body temperature ≤35 °C who were admitted to the emergency department (ED) of the University Hospital in Bern between 2000 and 2019. Results: 439 cases were included, corresponding to 0.32 per 1000 ED visits. Median age was 55 years (IQR 39–70). A total of 167 patients (38.0%) were female. Furthermore, 63.3% of the patients suffered from mild, 24.8% from moderate and 11.9% from severe hypothermia. Exposure as a single cause for accidental hypothermia accounted for 12 cases. The majority were combinations of hypothermia with trauma (32.6%), medical conditions (34.2%), neurological conditions (5.2%), intoxications (20.3%) or drowning (12.0%). Overall mortality was 22.3% and depended on the underlying causes, severity of hypothermia, age and sex.

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“…The methodology of this study is reported in accordance with the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 guidelines [11]. This study was approved by the ethics committee of Kyoto University (R-1045).…”

Section: Methodsmentioning

confidence: 99%

Predictive Accuracy of Biomarkers for Survival Among Cardiac Arrest Patients With Hypothermia: A Prospective Observational Cohort Study in Japan

Okada

Irisawa

Yoshiya

et al. 2020

Preprint

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Background:There is little information onthe predictive accuracy of commonly used predictors, such as lactate,pH or serum potassium for the survival among out-of-hospital cardiac arrest (OHCA) patients with hypothermia. This studyaimed to identify the predictive accuracy of these biomarkers forsurvival among OHCA patients with hypothermia.Methods: In this retrospective study, we analyzed the data from a multicenter, prospective nationwide registry among OHCA patients transported to emergency departments in Japan (the JAAM-OHCA Registry). We included all adult (≥18 years) OHCA patients with hypothermia (≤32.0°C)who were registeredfrom June 2014 to December 2017and whose blood test results on hospital arrival were recorded. We calculated the predictive accuracy of pH and lactate for 1-month survival.Results: Of the 34,754 patients in the JAAM-OHCA database, we included 754 patients from 66 hospitals. The 1-monthsurvival was 5.8% (44/754). The areas under the curve of the predictors were as follows: pH 0.829[0.767–0.877] and lactate 0.843[0.793–0.882]. On setting the cutoff points of 6.9 in pH, and 120 mg/dL (13.3 mmol/L) in lactate, the predictors had a high sensitivity (lactate: 0.91, and pH 0.91) and a low LR- (lactate: 0.14 and pH 0.13), which are suitable to rule-out 1-month survival.Conclusion: Among adult OHCA patients with hypothermia, pH 6.9 and lactate 120 mg/dLcan predictivelyrule out 1-month survival.

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Prevalence and outcomes of accidental hypothermia among elderly patients in Japan: Data from the J‐Point registry

Abstract: Approximately 80% of patients with AH were aged ≥65 years. The in-hospital mortality rate of patients aged ≥65 years was significantly higher than that of those aged <65 years. Geriatr Gerontol Int 2018; 18: 1427-1432.

Cited by 13 publications

References 15 publications

External validation of 5A score model for predicting in-hospital mortality among the accidental hypothermia patients: JAAM-Hypothermia study 2018–2019 secondary analysis

External validation of 5A score model for predicting in-hospital mortality among the accidental hypothermia patients: JAAM-Hypothermia study 2018–2019 secondary analysis

Accidental Hypothermia in a Swiss Alpine Trauma Centre—Not an Alpine Problem

Predictive Accuracy of Biomarkers for Survival Among Cardiac Arrest Patients With Hypothermia: A Prospective Observational Cohort Study in Japan

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