When do trauma patients lose temperature? - a prospective observational study

BackgroundThe prevalence of hypothermia in trauma patients is high and rapid recognition is important to prevent further heat loss. Hypothermia is associated with poor patient outcomes and is an independent predictor of increased mortality. The aim of this study was to analyze the changes in core body temperature of trauma patients during different treatment phases in the pre-hospital and early in-hospital settings. MethodsA prospective observational cohort study in severely injured patients. Continuous core temperature monitoring using an epitympanic sensor in the auditory canal was initiated at the scene of injury and continued for 3 h. The degree of patient insulation was photo-documented throughout, and graded on a binary scale. The outcome variable was temperature change in each treatment phase. ResultsTwenty-two patients were included with a median injury severity score (ISS) of 21 (IQR 14-29). Most patients (N = 16, 73%) were already hypothermic (< 36 degrees C) on scene at their first measurement. Twenty patients (91%) became colder at the scene of injury; on average, the decline was -1.7 degrees C/h. Full clothing reduced this value to -1.1 degrees C/h. Temperature remained essentially stable during ambulance and emergency department phases. ConclusionTrauma patients are at risk for hypothermia already at the scene of injury. Lay persons and professionals should focus on early prevention of heat loss. An active, individually tailored approach to counter hypothermia in trauma should begin immediately at the scene of injury and continue during transportation to hospital. Active rewarming during evacuation should be considered.