10.10 Does Hyperthermia On Admission Predict Poor Outcomes After Trauma?

Posted on December 22, 2014

A. Batool1, X. Tang2, F. Toy1, N. Becker1  1Geisinger Wyoming Valley Hospital,Department Of Trauma Surgery,Wilkes Barre, PA, USA 2Geisinger Medical Center,Department Of Biostatistics,Danville, PA, USA

Introduction:

The aim of this study is to determine whether hyperthermia in trauma patients predicts poor outcomes including increased mortality and longer hospital length of stay (LOS), ICU LOS, and ventilator dependence (VD).  A secondary aim was to assess if this effect remained significant in patients without severe head injury.

Methods:

The National Trauma Data Bank registry for the years 2010-2011 was obtained. All patients with age > 13 yrs with traumatic injury and admission temperature > 36 oC were stratified into normothermic (36-38oC) and hyperthermic (> 38oC) groups. Outcomes including mortality, LOS, ICU LOS, and VD were compared. A multivariate regression analysis was utilized to adjust for variables previously shown to effect outcomes. Subgroup analysis to assess the effect of hyperthermia on patients with and without significant head injury (GCS> 8) was performed.

Results:

The study included 857,178 patients. Of these, 7879 were hyperthermic.  Overall, patients with hyperthermia were found to have higher ISS, lower GCS, and were more likely to be hypotensive. Hyperthermic patients had higher mortality (6.7%) compared to normothermic patients (2.1%, p< 0.001).  In addition, hyperthermic patients had longer LOS, ICU LOS, and VD (all p values < 0.001 – table 1). After adjustment, hyperthermia remained an independent predictor of mortality [OR = 1.37 (95% CI 1.21-1.54)]. In subgroup analysis, irrespective of GCS score, patients with hyperthermia had increased mortality.

Conclusion:

Hyperthermia on admission is an independent predictor of mortality in trauma patients. In addition, it predicts longer LOS, ICU LOS, and VD.  These results are applicable to patients with and without head injury.  Further studies need to be done to determine the cause of these poor outcomes and to determine if hyperthermia prevention protocols need to be developed and implemented.