Risk factors for onset of hypothermia in trauma victims: The HypoTraum study
1 AP-HP, Urgences - SAMU 93, Unité recherche-enseignement-qualité, Hôpital Avicenne, 125, rue de Stalingrad, F-93000 Bobigny, France
2 Université Paris 13, Sorbonne Paris Cité, EA 3509, F-93000 Bobigny, France
3 SMUR, Centre Hospitalier de Gonesse, 25 rue Bernard Février, 95500 Gonesse, France
4 SAMU 83, Centre Hospitalier Intercommunal, 54, rue Henri Sainte Claire Deville BP 1412, 83056 Toulon cedex, France
5 Pôle Urgence-SAMU-SMUR, Hôpital Michallon, Boulevard de la Chantourne, 38701 La Tronche, France
6 SAMU 74, avenue de l'hôpital, 74374 Pringy, France
7 Pôle urgence-réanimation-SAMU 77, Centre Hospitalier Marc Jacquet, 11 Rue Freteau de Peny, 77000 Melun, France
8 SAMU 973, Centre Hospitalier Andrée Rosemon, 97306 Cayenne, Guyane Française, France
Critical Care 2012, 16:R142 doi:10.1186/cc11449Published: 31 July 2012
Hypothermia is common in trauma victims and is associated with an increase in mortality. Its causes are not well understood. Our objective was to identify the factors influencing the onset of hypothermia during pre-hospital care of trauma victims.
This was a multicenter, prospective, open, observational study in a pre-hospital setting.
The subjects were trauma victims, over 18 years old, receiving care from emergency medical services (EMS) and transported to hospital in a medically staffed mobile unit.
Study variables included: demographics and morphological traits, nature and circumstances of the accident, victim's presentation (trapped, seated or lying down, on the ground, unclothed, wet or covered by a blanket), environmental conditions (wind, rain, ground temperature and air temperature on site and in the mobile unit), clinical factors, Revised Trauma Score (RTS), tympanic temperature, care provided (including warming, drugs administered, infusion fluid temperature and volume), and EMS and hospital arrival times.
A total of 448 patients were included. Hypothermia (<35°C) on hospital arrival was present in 64/448 patients (14%). Significant factors associated with the absence of hypothermia in a multivariate analysis were no intubation: Odds Ratio: 4.23 (95% confidence interval 1.62 to 1.02); RTS: 1.68 (1.29 to 2.20); mobile unit temperature: 1.20 (1.04 to 1.38); infusion fluid temperature: 1.17 (1.05 to 1.30); patient not unclothed: 0.40 (0.18 to 0.90); and no head injury: 0.36 (0.16 to 0.83).
The key risk factor for the onset of hypothermia was the severity of injury but environmental conditions and the medical care provided by EMS were also significant factors. Changes in practice could help reduce the impact of factors such as infusion fluid temperature and mobile unit temperature.