Admission Hypo- or Hyperthermia and Survival After Trauma in Civilian and Military Environments
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Background In the care of patients with traumatic injuries, focus is placed on hypothermia secondary to its deleterious impact on the coagulation cascade. However, there is scant information on the mortality effect of hyperthermia. Study objectives We hypothesized that both hypothermia and hyperthermia are associated with decreased survival in patients with traumatic injuries. Furthermore, we hypothesized that in the military setting, the incidence of hyperthermia would be greater compared to the civilian environment and thus contributing to an increase in mortality. Methods Registries compared were the National Trauma Data Bank NTDB, three civilian Level I trauma centers, and military combat support hospitals. The NTDB was used as a reference to define hypothermia and hyperthermia based upon survival. Admission temperature and outcome were known for 4,093 civilian and 4,394 military records. Results Hypothermia was defined as 36 C and hyperthermia 38 C as mortality increased outside this range. The overall mortality rates were 3.5 for civilians and 2.5 for military p 0.05. Of civilians, 9.3 382 were hypothermic and 2.2 92 hyperthermic. The incidence of hypothermia in the military patients was 6.0 263 and for hyperthermia the incidence was 7.4 327. Irrespective of group, patients with hypothermia or hyperthermia had an increased mortality compared to those with normal temperatures, for civilianmilitary hypothermia 1211 normal 22 hyperthermia 144. Conclusion Care of the victim with traumatic injuries emphasizes avoidance of hypothermia however, hyperthermia is also detrimental. The presence of hypothermia or hyperthermia should be considered in the initial treatment of the patient with traumatic injuries.
- Anatomy and Physiology
- Medicine and Medical Research
- Stress Physiology