title: Effects of accidental hypothermia on posttraumatic complications and outcome in multiple trauma patients.
abstract: BACKGROUND
  Accidental hypothermia seems to predispose multiple trauma patients to the development of posttraumatic complications, such as Systemic Inflammatory Response Syndrome (SIRS), sepsis, Multiple Organ Dysfunction Syndrome (MODS), and increased mortality. However, the role of accidental hypothermia as an independent prognostic factor is controversially discussed. The aim of the present study was to evaluate the incidence of accidental hypothermia in multiple trauma patients and its effects on the development of posttraumatic complications and mortality.
  
  
  METHODS
  Inclusion criteria for patients in this retrospective study (2005-2009) were an Injury Severity Score (ISS) ≥16, age ≥16 years, admission to our Level I trauma centre within 6h after the accident. Accidental hypothermia was defined as body temperature less than 35°C measured within 2 h after admission, but always before first surgical procedure in the operation theatre. The association between accidental hypothermia and the development of posttraumatic complications as well as mortality was investigated. Statistical analysis was performed with χ(2)-test, Student's t-test, ANOVA and logistic regression. Statistical significance was considered at p<0.05.
  
  
  RESULTS
  310 multiple trauma patients were enrolled in the present study. Patients' mean age was 41.9 (SD 17.5) years, the mean injury severity score was 29.7 (SD 10.2). The overall incidence of accidental hypothermia was 36.8%. The overall incidence of posttraumatic complications was 77.4% (SIRS), 42.9% (sepsis) and 7.4% (MODS), respectively. No association was shown between accidental hypothermia and the development of posttraumatic complications. Overall, 8.7% died during the posttraumatic course. Despite an increased mortality rate in hypothermic patients, hypothermia failed to be an independent risk factor for mortality in multivariate analysis.
  
  
  CONCLUSIONS
  Accidental hypothermia is very common in multiply injured patients. However, it could be assumed that the increase of mortality in hypothermic patients is primarily caused by the injury severity and does not reflect an independent adverse effect of hypothermia. Furthermore, hypothermia was not shown to be an independent risk factor for posttraumatic complications.
authors: Trauma Department, Hannover Medical School, 30625 Hannover, Germany. mommsen.philipp@mh-hannover.de
authors: P
authors: P
authors: Mommsen
authors: H
authors: H
authors: Andruszkow
authors: C
authors: C
authors: Frömke
authors: C
authors: C
authors: Zeckey
authors: U
authors: U
authors: Wagner
authors: M
authors: M
authors: van Griensven
authors: M
authors: M
authors: Frink
authors: C
authors: C
authors: Krettek
authors: F
authors: F
authors: Hildebrand
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D009104:Multiple Trauma / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data