title: Accidental hypothermia: rewarming treatments, complications and outcomes from one university medical centre.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 occurred: pulmonary, renal and neurological complications in 20, 17 and 10 patients respectively. Seventeen patients had 2 or more late complications. Twenty-four patients (28.6%) died: 10 during rewarming and 14 after rewarming was completed. Prognosis was poor in older and colder patients and after indoor exposure and submersion.
  
  
  CONCLUSIONS
  AH is a rare diagnosis in an inhomogeneous population, treated with a large variety of rewarming techniques. Most complications and death occurred late, after rewarming was completed. Because individual teams gain little clinical experiences, we suggest multiple centre data collection as a first step towards an evidence-based standard of care.
authors.affiliation: VU University Medical Centre, De Boelelaan 1117, 1007 MB Amsterdam, The Netherlands. gj.vdploeg@quicknet.nl
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: van der Ploeg
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.forename: Beat H
authors.initials: BH
authors.lastname: Walpoth
authors.forename: Joost J L M
authors.initials: JJ
authors.lastname: Bierens
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001831:Body Temperature; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D017694:Rewarming / Q000379:methods*; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome