Introduction
Methods
Study design and setting
Inclusion and exclusion criteria
Study variables
Temperature and wind measurements
Primary endpoint
Statistical analysis
Results
Hôpital | Inclusions Number | Patients with hypothermia on arrival Number (%) | Median air temperature °CI (25 to 75 percentiles) |
---|---|---|---|
Bobigny | 251 | 31 (12) | 17.5 (10.8-23.0) |
Gonesse | 99 | 8 (8) | 16.7 (9.0-21.6) |
Brest | 39 | 15 (41) | 14.4 (11.0-19.2) |
Grenoble | 22 | 4 (18) | 6.2 (-2.0-20.0) |
Annecy | 14 | 5 (36) | 14.8 (12.4-20.3) |
Voiron | 11 | 0 (0) | 16.1 (8.4-20.4) |
Melun | 10 | 1 (10) | 23.5 (21.0-25.4) |
Cayenne | 2 | 0 (0) | 26.0 (25.4-29.7) |
Total | 448 | 64 (14) | 17.0 (10.3-22.3) |
Patients with hypothermia on arrival at hospital | Patients without hypothermia on arrival at hospital |
P
| |
---|---|---|---|
Demographics and morphological traits
| |||
Age (yearrs) | 36 (23-53) | 33 (23-44) | 0.2 |
Male - Number (%) | 49 (77) | 275 (72) | 0.7 |
Body weight (kg) | 72 (60-80) | 72 (65-80) | 0.6 |
Height (cm) | 172 (169-180) | 174 (166-180) | 0.9 |
Body Mass Index | 24.2 (21.2 - 27.7) | 24.5 (21.8 - 26.9) | 0.5 |
Circumstances of accident - Number (%)
| |||
Road accident | 32 (50) | 220 (57) | 0.06 |
Fall | 23 (36) | 117 (30) | |
Weapon (gun or knife) | 2 (3) | 18 (5) | |
Other | 7 (11) | 29 (8) | |
Environmental conditions
| |||
Daytime - Number (%) | 37 (58) | 262 (68) | 0.5 |
Winter - Number (%) | 20 (32) | 110 (29) | 0.09 |
Spring - Number (%) | 14 (22) | 91 (24) | |
Summer - Number (%) | 12 (19) | 105 (27) | |
Autumn - Number (%) | 18 (28) | 78 (20) | |
Indoors - Number (%) | 10 (16) | 72 (19) | 0.6 |
Air temperature (°C) | 11.5 (6.7-16.4) | 17.9 (11.0-23.0) | 0.0001 |
Ground temperature (°C) | 11.4 (7.1-17.1) | 18.1 (11.1-22.9) | <0.0001 |
Windy - Number (%) | 8 (13) | 28 (7) | 0.2 |
Rain - Number (%) | 10 (16) | 37 (9) | 0.3 |
Patients with hypothermia on arrival at hospital | Patients without hypothermia on arrival at hospital |
P
| |
---|---|---|---|
Trauma victims - Number (%) | 62 (13) | 399 (87) | |
Presentation of victim
| |||
Trapped - Number (%) | 7 (11) | 51 (13) | 0.6 |
Seated - Number (%) | 6 (9) | 61 (16) | 0.2 |
Lying - Number (%) | 58 (91) | 319 (83) | |
On the ground - Number (%) | 51 (80) | 215 (56) | 0.01 |
Unclothed - Number (%) | 25 (39) | 117 (30) | 0.2 |
Covered by a blanket - Number (%) | 33 (53) | 194 (49) | 0.8 |
Wet - Number (%) | 14 (22) | 34 (9) | 0.01 |
Clinical examination
| |||
Head injury - Number (%) | 45 (70) | 165 (43) | 0.0001 |
Chest injury - Number (%) | 24 (37) | 112 (29) | 0.2 |
Abdominal injury - Number (%) | 7 (11) | 51 (13) | 0.8 |
Hip injury - Number (%) | 10 (16) | 66 (17) | 1 |
Limb injury - Number (%) | 33 (52) | 149 (39) | 0.04 |
Glasgow Coma Score (GCS) | 12 (5-15) | 15 (15-15) | 0.0001 |
Systolic blood pressure (mmHg) | 118 (74-139) | 125 (110-140) | 0.01 |
Heart rate (bpm) | 88 (70-110) | 88 (75-100) | 0.5 |
Respiratory rate (breaths/min) | 18 (15-24) | 18 (16-22) | 0.6 |
Pulse oxymetry (SpO2) | 98 (96-100) | 99 (97100) | 0.2 |
Revised Trauma Score (RTS) | 10 (8-11) | 11 (11-11) | <0.0001 |
Initial tympanic temperature (°C) | 34.2 (33.2-34.8) | 35.7 (35.1-36.4) | <0.0001 |
On-site management
| |||
Time from accident to EMS arrival (min) | 30 (22-43) | 30 (24-45) | 0.8 |
Mobile unit temp on arrival (°C) | 21.7 (19.6-23.0) | 22.0 (20.0-25.2) | <0.0001 |
Lowest mobile unit temperature (°C) | 19.8 (18.0-22.0) | 21.7 (19.7-24.9) | <0.0001 |
Vascular filling volume (ml) | 510 (300-1250) | 300 (210-500) | <0.0001 |
Infusion fluid temperature (°C) | 19.5 (17.7-21.0) | 22.0 (19.2-24.9) | <0.0001 |
Catecholamine - Number (%) | 9 (14) | 7 (2) | <0.0001 |
Orotracheal intubation - Number (%) | 32 (50) | 25 (7) | <0.0001 |
Morphine - Number (%) | 37 (58) | 223 (58) | 1 |
Warming - Number (%)a | 56 (87) | 284 (74) | 0.03 |
Time from EMS arrival to hospital admission (min) | 65 (53-90) | 60 (45-75) | 0.01 |
Factors for absence of hypothermia | Odds Ratio (95% CI) |
P
|
---|---|---|
No intubation | 4.23 (1.61-11.02) | 0.003 |
Revised Trauma Score | 1.68 (1.29-2.20) | 0.0001 |
Mobile unit temperature on arrival on site | 1.20 (1.04-1.38) | 0.01 |
Infusion fluid temperature | 1.17 (1.05-1.30) | 0.003 |
Patient not unclothed | 0.40 (0.18-0.90) | 0.03 |
No head injury | 0.36 (0.16-0.83) | 0.01 |
Discussion
Conclusions
Key messages
-
Routine temperature measurements should help improve the care of trauma victims.
-
The severity of injury was associated with hypothermia on the victim's arrival at hospital.
-
Mobile unit and infusion fluid temperature should be measured and increased if necessary.
-
Unclothing of patients should be avoided.