Factors associated with severity of accidental hypothermia: A cohort retrospective multi-institutional study (original) (raw)
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Resuscitation, 2010
Accidental hypothermia (AH) is a complex and life threatening condition. Knowledge about epidemiology, rewarming treatments, complications and outcome is limited. This study was initiated to obtain data on causes, rewarming treatments and complications. A retrospective cohort study of all patients with a body temperature ≤ 35°C admitted to the Emergency Department (ED) of the VU university medical centre, Amsterdam, The Netherlands, between January 1, 2000 and August 31, 2008. A predefined set of epidemiological and clinical data was retrieved. Eighty-four patients were included (median age: 47 years). Categories of hypothermia included immersion (18), submersion (29) and exposure to cold (37); concomitant factors were intoxication (26), trauma (40) and homelessness (7). Temperature at admission in the ED was 31.6 ± 2.6°C (mean ± SD), lowest temperature 24.2°C. Fourteen different rewarming treatments were used resulting in a wide range of rewarming speeds. Seventy-nine complications...
Accidental Hypothermia: 2021 Update
International Journal of Environmental Research and Public Health, 2022
Accidental hypothermia is an unintentional drop of core temperature below 35 °C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature < 30 °C in young and healthy patients and <32 °C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure < 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient a...
Hypothermia and mortality and morbidity. An epidemiological analysis
Journal of Epidemiology & Community Health, 1991
Study objective-The aim was to identify socioeconomic variables associated with deaths and hospital admissions due to hypothermia and to quantify the risk due to ambient outside temperature. Design-The study was a survey of deaths and hospital admissions due to hypothermia (ICD 991.6), for the period 1979-85 inclusive, identified from death certificates and Hospital Inpatient Enquiry (HIPE) data. Setting-The study included all deaths and hospital admissions due to hypothermia (1979-85) in the 26 counties of the Republic of Ireland, population 3 5 million. Subjects-All deaths coded during the study period as being due to hypothermia and all persons admitted to hospital during the study period for whom hypothermia was recorded as a discharge diagnosis in HIPE data. Details of age, sex, marital status, county of residence, and any recorded diagnoses or causes of
Investigation of Inadvertent Hypothermia Incidence and Risk Factors
2018
Objective: This study was conducted to determine the incidence of inadvertent hypothermia in operative patients and the risk factors that are involved in the development of hypothermia. Material and Methods: This prospective, descriptive, cross-sectional study was conducted from January 2016to Au- gust 2016 with 144 patients who over the age of 18 years, underwent general surgery, orthopedic surgery, urologic surgery, neurosurgery, and plastic and reconstructive surgery. Data was collected with the “Hypothermia Data Col- lection Form.” Body temperature was measured by the tympanic membrane in the waiting room, operating room, and PACU. Results: Overall, 89% of the patients (n=129) were normothermic in the preoperative phase; 74.30% of the patients (n=107) in intraoperative phase and 75.70% of the patients (n=109) in postoperative phase were hypothermic. American Society of Anesthesiologist (ASA) score, preoperative body temperature, operating room temperature, and using heating method at operation were found to be effective in the development of inadvertent hypothermia during the operating period. It was determined that premedication, preoperative and postoperative body tempera- ture, and the operating room temperature were effective for inadvertent hypothermia in the postoperative period. Conclusion: As a result of the study, it was determined the rate of inadvertent hypothermia was high during and after surgery. Preoperative and intraoperative patient body temperature and operating room temperature were found to be effective in preventing inadvertent hypothermia. Keywords: Inadvertent hypothermia, Incidence, Risk factors, Operating room
Multy-system complications of accidental hypothermia: A case report
Medical review, 2020
Introduction. Accidental hypothermia is an unintentional fall in core temperature to less than 35?C and it occurs when the body?s heat loss exceeds its heat production. The elderly population is particularly susceptible due to reduced adaptability to low temperatures and various comorbidities, which may be predisposing factors. Case Report. A 65-year-old Caucasian female was admitted to the hospital due to hypothermia (< 34?C), severe hypoglycemia (0.7 mmol/L), metabolic acidosis (6.970), elevated urea (42.4 mmol/L) and creatinine (686 ?mol/L). The initial examination revealed shivering, dysarthria and general exhaustion. Hyperamylasemia (241 U/L) and hyperlipasemia (1920 U/L) were found on the second day after admission. Contrast enhanced computed tomography showed a focal asymmetric enlargement of the pancreatic head and body. Furthermore, a splenic infarction was also noticed. The complexity of human thermoregulatory mechanisms indicates the importance of precipitating factors...
Resuscitation, 2011
Background: Serious sequelae have been associated with injured patients who are hypothermic (<35 • C) including coagulopathy, acidosis, decreased myocardial contractility and risk of mortality. Aim: Establish the incidence of accidental hypothermia in major trauma patients and identify causative factors. Method: Prospective identification and subsequent review of 732 medical records of major trauma patients presenting to an Adult Major Trauma Centre was undertaken between January and December 2008. Multivariate analysis was performed using logistic regression. Significant and clinically relevant variables from univariate analysis were entered into multivariate models to evaluate determinants for hypothermia and for death. Goodness of fit was determined with the use of the Hosmer-Lemeshow statistic. Main results: Overall mortality was 9.15%. The incidence of hypothermia was 13.25%. The mortality of patients with hypothermia was 29.9% with a threefold independent risk of death: OR (CI 95%) 3.44 (1.48-7.99), P = 0.04. Independent determinants for hypothermia were pre-hospital intubation: OR (CI 95%) 5.18 (2.77-9.71), P < 0.001, Injury Severity Score (ISS): 1.04 (1.01-1.06), P = 0.01, Arrival Systolic Blood Pressure (ASBP) < 100 mm Hg: 3.04 (1.24-7.44), P = 0.02, and wintertime: 1.84 (1.06-3.21), P = 0.03. Of the 87 hypothermic patients who had repeat temperatures recorded in the Emergency Department, 77 (88.51%) patients had a temperature greater than the recorded arrival temperature. There was no change in recorded temperature for four (4.60%) patients, whereas six (6.90%) patients were colder at Emergency Department discharge. Conclusion: Seriously injured patients with accidental hypothermia have a higher mortality independent of measured risk factors. For patients with multiple injuries a coordinated effort by paramedics, nurses and doctors is required to focus efforts toward early resolution of hypothermia aiming to achieve a temperature >35 • C.
Additional risk factors for lethal hypothermia
Journal of Forensic and Legal Medicine, 2013
An 86-year-old woman was found dead lying on her back on the floor of an unkempt kitchen. She had last been seen four days before. Her dress was pulled up and she was not wearing underpants. The house was noted to be in "disarray" with papers covering most surfaces and the floor. Rubbish was piled up against one of the doors. At autopsy the major findings were of a fractured left neck of femur, fresh pressure areas over her right buttock, Wischnewski spots of the stomach and foci of pancreatic necrosis, in keeping with hypothermia. No significant underlying organic diseases were identified and there was no other evidence of trauma. Death was due to hypothermia complicating immobility from a fractured neck of femur. This case confirms the vulnerability of frail, elderly and socially-isolated individuals to death from hypothermia if a significant illness or injury occurs. Additional risk factors for hypothermia are also illustrated in this case that involve inadequate housing construction with absent insulation and window double glazing. The approach to hypothermic deaths should, therefore, include checking for these features as well as measuring room and environmental temperatures, evaluating the type and quality of heating and the nature of the floor and its coverings, Given the ageing population in many Western countries, increasing social isolation of the elderly, cost of fuel and electricity, and lack of energy efficient housing, this type of death may become an increasingly witnessed occurrence during the colder months of the year.
Wilderness & Environmental Medicine, 2014
To provide guidance to clinicians, the Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the out-of-hospital evaluation and treatment of victims of accidental hypothermia. The guidelines present the main diagnostic and therapeutic modalities and provide recommendations for the management of hypothermic patients. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according the criteria published by the American College of Chest Physicians. The guidelines also provide suggested general approaches to the evaluation and treatment of accidental hypothermia that incorporate specific recommendations. This is an updated version of the original Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia published in Wilderness & Environmental Medicine 2014;25(4):425-445.
Physiological Changes in Subjects Exposed to Accidental Hypothermia: An Update
Frontiers in Medicine, 2022
BackgroundAccidental hypothermia (AH) is an unintended decrease in body core temperature (BCT) to below 35°C. We present an update on physiological/pathophysiological changes associated with AH and rewarming from hypothermic cardiac arrest (HCA).Temperature Regulation and MetabolismTriggered by falling skin temperature, Thyrotropin-Releasing Hormone (TRH) from hypothalamus induces release of Thyroid-Stimulating Hormone (TSH) and Prolactin from pituitary gland anterior lobe that stimulate thyroid generation of triiodothyronine and thyroxine (T4). The latter act together with noradrenaline to induce heat production by binding to adrenergic β3-receptors in fat cells. Exposed to cold, noradrenaline prompts degradation of triglycerides from brown adipose tissue (BAT) into free fatty acids that uncouple metabolism to heat production, rather than generating adenosine triphosphate. If BAT is lacking, AH occurs more readily.Cardiac OutputAssuming a 7% drop in metabolism per °C, a BCT decreas...