The effect of admission spontaneous hypothermia on patients with severe traumatic brain injury

Abstract

Introduction Recent information has emerged regarding the harmful effects of spontaneous hypothermia at time of admission in trauma patients. However the volume of evidence regarding the role of spontaneous hypothermia in TBI patients is inadequate. Methods We performed secondary data analysis of 10 years of the Pennsylvania trauma outcome study (PTOS) database. Unadjusted comparisons of the association of admission spontaneous hypothermia with mortality were performed. In addition, full assessment of the association of hypothermia with mortality was conducted using multivariable logistic regressions reporting the odds ratios (OR) with the 95% confidence intervals (CI) and p-values. Results There were 11,033 patients identified from the PTOS with severe TBI. There were 4,839 deaths (43.9%). The proportion of deaths in hypothermic patients was higher than the proportion of deaths in normothermic patients (53.9% vs. 37.4% respectively; P value <0.001). In a multivariable logistic regression model adjusted for demographics, injury characteristics, and information at admission to the trauma centre, the odds of death among patients with hypothermia were 1.70 times the odds of death among patients with normothermia (OR 1.70, 95%CI 1.50–1.93), indicating that the probability of death was significantly higher when patients arrived hypothermic at the trauma centre. Conclusion The presence of spontaneous hypothermia at hospital admission is associated with a significant increase in the risk of mortality in patients with severe TBI. The benefit of maintaining normothermia in severe TBI patients, the impact of prolonged re-warming in patients with established hypothermia and the introduction of prophylactic measures to complications of hypothermia are key points that require further investigation.

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

“…In a retrospective study of 604 trauma patients who required massive transfusion, a logistic regression analysis demonstrated that a temperature lower than 34 °C was associated with a greater independent risk of mortality of more than 80 % after controlling for differences in shock, coagulopathy, injury severity and transfusion requirements (OR 1.87; 95 % CI 1.18 to 3.0; P = 0.007) [ 303 ]. A recent study performed a secondary data analysis of 10 years of the Pennsylvania Trauma Outcome Study (PTOS), which analysed 11,033 patients with severe TBI and demonstrated that spontaneous hypothermia at hospital admission was associated with a significant increase in the risk of mortality in patients with severe TBI [ 304 ]. Steps to prevent hypothermia and the risk of hypothermia-induced coagulopathy include removing wet clothing, covering the patient to avoid additional heat loss, increasing the ambient temperature, forced air warming, warm fluid therapy, and, in extreme cases, extracorporeal re-warming devices [ 305 – 307 ].…”

Traumatic Brain Injury Pathophysiology and Treatments: Early, Intermediate, and Late Phases Post-Injury

“…Early research corroborated such variability by finding spontaneous hypothermia upon time of admission to be associated with poorer prognosis [44–46]. Thus, it may be said that hypothermia administration is as heterogeneous as the TBI pathology itself.…”

Hypothermia as a predictor for mortality in trauma patients at admittance to the intensive care unit

“…Accidental hypothermia on the emergency department (ED) is frequently observed in trauma patients and is associated with poor outcomes,[ 1 2 3 4 5 6 7 8 ] although not all studies provided consistent results. [ 9 10 ] Hypothermia in trauma patients is generally defined as a core temperature of ≤35°C.…”