Early hypothermia as risk factor in severely burned patients: A retrospective outcome study |
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| Affiliation: | 1. Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany;2. Department of Orthopaedic and Trauma Surgery, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany;3. Burn Center and Plastic Surgery, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683 Berlin, Germany;1. College of Medical and Dental Sciences, University of Birmingham, United Kingdom;2. Queen Elizabeth Hospital Birmingham, United Kingdom;3. West Midlands Fire Service, United Kingdom;1. University of Texas Southwestern Medical Center, Department of Surgery, Division of Burn, Trauma, and Critical Care, Dallas, TX, USA;2. University of Kentucky, Department of Internal Medicine, Division of Nephrology, Bone, and Mineral Metabolism Lexington, KY, USA;3. University of Texas Southwestern Medical Center, Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, Dallas, TX, USA;1. Department of Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou, China;2. Department of Burns & Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China;3. Department of Burns, The First Affiliated Hospital of Nanchang University, Nanchang, China;4. Department of Burns, Ganzhou Municipal Hospital of Jiangxi Province, Ganzhou, China;5. Institute of Burn Research, Southwest Hospital, State Key Laboratory of Trauma, Burns and Combined Injury, The Third Military Medical University, Chongqing, China;6. Department of Burns, Affiliated Jinan Central Hospital, Shandong University, Jinan, China;7. Department of Epidemiology, Institute of Geriatrics, PLA General Hospital, Beijing, China;1. Unidad de Quemados, Hospital Universitario Río Hortega, Valladolid, Spain;2. Bloque Quirúrgico, Hospital Clínico Universitario de Valladolid, Valladolid, Spain;1. Department of Anaesthesia and Intensive Care, The Royal London Hospital, London, UK;2. Department of Anaesthesia and Intensive Care, St. Andrew''s Burn Centre, Chelmsford, UK;3. Medical Statistician, Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK;1. Department of Pediatric Surgery, Burn Unit, Plastic and Reconstructive Surgery, Altona Children’s Hospital, Bleickenallee 38, 22763 Hamburg, Germany;2. Department of Plastic and Aesthetic Surgery, Helios Hospital Berlin Buch, Schwanenbecker Chaussee 50, 13125 Berlin, Germany;3. German Society for Burn Treatment (DGV), Committee of the German Burn Registry, Luisenstrasse 58-59, 10117 Berlin, Germany;4. Department for Plastic and Reconstriuctive Surgery, Burn Care Center, Cologne Merheim Medical Center, University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109 Cologne, Germany;5. Department of Pediatric Surgery, University Medical Center Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany |
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| Abstract: | IntroductionBurn trauma-related hypothermia is a frequent observation but risk factors and impact on patient related outcome are ambiguously reported. It is expected that hypothermia is associated with increased mortality and reduced overall outcome in severely burned patients, but available evidence is limited.MethodsThis retrospective single-center-study reviewed preclinical service protocols and medical records of patients sustaining a burn with a total body surface area (TBSA) ≥15% from 2008 to 2012. General patient and burn specific characteristics, outcome parameters as well as body temperature at admission measured via urine catheter or nasal temperature probe were recorded and statistically analyzed comparing normothermic (≥36 °C), mild hypothermic (<36 °C) and severely hypothermic (<34.5 °C) patients. Chi-square test was performed to demonstrate impact of hypothermia on primary outcome parameters and to reveal risk factors for developing hypothermia. To assess independent influences on mortality, a multivariate logistic regression analysis was performed.ResultsOut of 300 patients matching inclusion criteria, a sufficient record of temperature was found in 144 patients (48%). Out of 141 eligible patients with an average burn extent (SD) of 33.38% (24.5%) TBSA, 31.9% (n = 45) suffered from severe hypothermia (<34.5 °C) and 28.4% (n = 40) showed mild hypothermia. Total burn extent, presence of full thickness burns, presence of inhalation injury, preclinical mechanical ventilation and administration of sedative drugs were risk factors for developing hypothermia. Patients’ age, total burn extent and presence of full thickness burns could be identified as independent factor for mortality. Although a trend towards an independent positive influence of normothermia at admission on mortality was seen, it was not statistically significant.ConclusionIncidental hypothermia of burned patients is associated with an increased mortality and needs to be addressed by emergency health care providers and immediately at the burn center. Especially patients with extensive burns, full-thickness burns, inhalation injury or patients undergoing preclinical intubation are at risk for hypothermia and benefit from any measures for temperature preserving. |
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| Keywords: | Hypothermia Mortality Burns Preclinical treatment |
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