title: The association between hypothermia, prehospital cooling, and mortality in burn victims.
abstract: OBJECTIVE
  Hypothermia is associated with increased morbidity and mortality in trauma victims. The prognostic value of hypothermia on emergency department (ED) presentation in burn victims is not well known. The objective of this study was to determine the incidence of hypothermia in burn victims and its association with mortality and hospital length of stay (LOS). The study also examined the potential causative role of prehospital cooling in hypothermic burn patients.
  
  
  METHODS
  This was a retrospective review of a county trauma registry. The county was both suburban and rural, with a population of 1.5 million and with one burn center. Burn patients between 1994 and 2007 who met trauma registry criteria were included. Demographic and clinical data including prehospital cooling, burn size and depth, and presence of inhalation injury were collected. Hypothermia was defined as a core body temperature of less than or equal to 35 degrees C. Data analysis consisted of univariate associations between patient characteristics and hypothermia.
  
  
  RESULTS
  There were 1,215 burn patients from 1994 to 2007. Mean age (+/-standard deviation [+/-SD]) was 29 (+/-24) years, 67% were male, 248 (26.7%) had full-thickness burns, and 24 (2.6%) had inhalation injury. Only 17 (1.8%) had a burn larger than 70% total body surface area (TBSA). A total of 929 (76%) patients had an initial ED temperature recorded. Only 15/929 (1.6%) burn patients had hypothermia on arrival, and all were mild (lowest temperature was 32.6 degrees C). There was no association between sex, year, and presence of inhalation injury with hypothermia. Hypothermic patients were older (44 years vs. 29 years, p = 0.01), and median Injury Severity Score (ISS) was higher (25 vs. 4, p = 0.002) than for nonhypothermic patients. Hypothermia was present in 6/17 (35%) patients with a TBSA of 70% or greater and in 8/869 (0.9%) patients with a TBSA of <70% (p < 0.001). Mortality was higher in hypothermic patients (60% vs. 3%, p < 0.001). None of the hypothermic patients received prehospital cooling.
  
  
  CONCLUSIONS
  Hypothermia on presentation to the ED was noted in 1.6% of all burn victims in this trauma registry. Hypothermia was more common in very large burns and was associated with high mortality. In this series, prehospital cooling did not appear to contribute to hypothermia.
authors.affiliation: Department of Emergency Medicine, Stony Brook University, Stony Brook, NY, USA. adam.singer@stonybrook.edu
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
authors.forename: Breena R
authors.initials: BR
authors.lastname: Taira
authors.forename: Henry C
authors.initials: HC
authors.lastname: Thode
authors.forename: Jane E
authors.initials: JE
authors.lastname: McCormack
authors.forename: Mark
authors.initials: M
authors.lastname: Shapiro
authors.forename: Ani
authors.initials: A
authors.lastname: Aydin
authors.forename: Christopher
authors.initials: C
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D002053:Burn Units; D002056:Burns / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D002423:Cause of Death; D002648:Child; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007035:Hypothermia / Q000150:complications / Q000401:mortality*; D007036:Hypothermia, Induced / Q000009:adverse effects* / Q000379:methods; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D055815:Young Adult