Initial Admission Core Body Temperature Is a Better Predictor of Survival in Trauma Patients than Time to Normothermia.

C. Piercecchi, K. A. Snyder, R. S. Friese, J. L. Wynne, R. Latifi, N. Kulvatunyou, P. Rhee, T. O’Keeffe; University of Arizona, Tucson, AZ

Hypothermia on arrival has been shown to be a predictor of morbidity and mortality in trauma patients. No studies to date have examined the effect on outcome of the length of time taken by a hypothermic patient to achieve a normal core body temperature. Our hypothesis was that the time required to achieve normothermia is a better predictor of mortality than the initial core body temperature.

Methods: All trauma patients admitted to a surgical Intensive Care Unit (ICU) at a level I trauma center in 2008 were retrospectively analyzed to identify their presenting core body temperature in the Emergency Department (ED). For the purposes of this study we defined hypothermia as an initial temperature of less than 36 degrees Centigrade (C). Time taken to achieve normothermia was calculated from data extracted from the electronic medical record. We compared crude mortality between hypothermic and normothermic patients using Chi-square analysis, and then used a multivariate logistic regression model to adjust for confounders such as age, sex, injury severity as well as time required to achieve normothermia. Results are presented as proportions or means 6 Standard Deviation.

Results: See http://www.journalofsurgicalresearch.com/article/PIIS0022480409012426/abstract?rss=yes

In the multivariate logistic regression model, independent predictors of mortality included age, Head AIS, Injury severity score 25 or above, and temperature less than 35C. Time to achieve normothermia was NOT a predictor of mortality.

Conclusions: Even mild hypothermia of less than 36C was associated with decreased survival in trauma patients admitted to the ICU. Initial Emergency Department core body temperature was a better predictor of mortality than the length of time taken to achieve normothermia. Pre-hospital temperature conservation is an important part of trauma care, and should not be neglected.