title: Hypothermia and rapid rewarming is associated with worse outcome following traumatic brain injury.
abstract: OBJECTIVE
  The purpose of the present study was to determine (1) the prevalence and degree of hypothermia in patients on emergency department admission and (2) the effect of hypothermia and rate of rewarming on patient outcomes.
  
  
  METHODS
  Secondary data analysis was conducted on patients admitted to a level I trauma center following severe traumatic brain injury (n = 147). Patients were grouped according to temperature on admission according to hypothermia status and rate of rewarming (rapid or slow). Regression analyses were performed.
  
  
  RESULTS
  Hypothermic patients were more likely to have lower postresuscitation Glasgow Coma Scale scores and a higher initial injury severity score. Hypothermia on admission was correlated with longer intensive care unit stays, a lower Glasgow Coma Scale score at discharge, higher mortality rate, and lower Glasgow outcome score-extended scores up to 6 months postinjury (P < .05). When controlling for other factors, rewarming rates more than 0.25°C/h were associated with lower Glasgow Coma Scale scores at discharge, longer intensive care unit length of stay, and higher mortality rate than patients rewarmed more slowly although these did not reach statistical significance.
  
  
  CONCLUSIONS
  Hypothermia on admission is correlated with worse outcomes in brain-injured patients. Patients with traumatic brain injury who are rapidly rewarmed may be more likely to have worse outcomes. Trauma protocols may need to be reexamined to include controlled rewarming at rates 0.25°C/h or less.
authors.affiliation: Biobehavioral Nursing and Health Systems, University of Washington, Seattle, Washington, USA. hilairet@uw.edu
authors.forename: Hilaire J
authors.initials: HJ
authors.lastname: Thompson
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Kirkness
authors.forename: Pamela H
authors.initials: PH
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D017052:Hospital Mortality; D006801:Humans; D007035:Hypothermia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010343:Patient Admission / Q000706:statistics & numerical data; D015995:Prevalence; D012151:Resuscitation / Q000009:adverse effects / Q000379:methods; D017694:Rewarming / Q000009:adverse effects / Q000379:methods; D014193:Trauma Centers; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology