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Impact of hypothermia in the rural, pediatric trauma patient*

Waibel, Brett H. MD; Durham, Chris A. MD; Newell, Mark A. MD; Schlitzkus, Lisa L. MD; Sagraves, Scott G. MD; Rotondo, Michael F. MD

Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e3181b80500
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Abstract

Objective: Hypothermia is an independent predictor of mortality in adult trauma studies. However, the impact of hypothermia on the pediatric trauma population has not been described. The purpose of this study is to evaluate hypothermia as a cofactor to mortality, complications, and among survivors, hospital length of stay parameters in the pediatric trauma population.

Design: Retrospective review of a prospectively collected database (National Trauma Registry of the American College of Surgeons) over a 5-yr period (July 2002 to June 2007).

Setting: A rural, level I trauma center.

Patients: One thousand six hundred twenty-nine pediatric patients admitted with a traumatic injury.

Interventions: None.

Measurements and Main Results: Multivariate regression models were used to evaluate the association of hypothermia with mortality, infectious complications, organ dysfunction, and among survivors, hospital length of stay parameters. Of 1,629 pediatric trauma patients admitted, 182 (11.1%) patients were hypothermic (temperature below 36°C) on admission. Hypothermia had an adjusted odds ratio (AOR) of 2.41 (95% confidence interval [CI], 1.12–5.22, p = .025) for mortality. After controlling for covariates, hypothermia had associations with developing pneumonia (AOR, 0.185, 95% CI, 0.040–0.853; p = .031) and a bleeding diathesis (AOR, 3.14, 95% CI, 1.04–9.44; p = .042). The median days in the hospital, intensive care unit (ICU), and ventilator were longer in the hypothermic cohort; however, after controlling for covariates, hypothermia was not associated with differences in hospital days, ICU days, or ventilator days.

Conclusions: Hypothermia is a common problem at admission among pediatric trauma patients. Hypothermia is associated with an increase in the odds of death and the development of a bleeding diathesis, while having decreased odds for developing pneumonia. While the length of stay indicators were longer in the hypothermic cohort among survivors, no significant association was noted with hypothermia for hospital, ICU, or ventilator days after controlling for confounders.

Author Information

From the Department of Surgery, Division of Trauma and Surgical Critical Care, The Brody School of Medicine, East Carolina University, Greenville, NC.

*See also p. 301.

Presented as “Hypothermia and the Pediatric Rural Trauma Patient” at the 38th Critical Care Congress (SCCM), Nashville, TN, January/February 2009.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: Brett.Waibel@pcmh.com

©2010The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies