Shahid Shafi1, Alan C Elliott, Larry Gentilello. 1. Department of Surgery, Division of Burn, Trauma and Surgical Critical Care, University of Texas Southwestern Medical School, Dallas, Texas 75390-9158, USA. shahid.shafi@utsouthwestern.edu
Abstract
BACKGROUND: Successful application of induced hypothermia (HT) after stroke and cardiac arrest has led to a resurgence of interest in its potential protective effects in trauma patients. Although clinical studies demonstrate an adverse effect, they consist of small studies from single institutions. We tested the hypothesis that HT is associated with improved survival in trauma patients by analyzing a large, national trauma database. METHODS: The study included all patients in the National Trauma Data Bank (1994-2002) aged 18 to 55 years old with temperature at presentation to the emergency department and base deficit (BD) recorded. Hypothermic (temperature, <35 degrees C; n = 3267) patients and patients with normothermia (temperature, > or =35 degrees C; n = 35,283) patients were compared. Two analyses were conducted to control for the association between HT and injury severity. First, hypothermic and normothermic (NT) patients were stratified by injury severity score (ISS) and shock (blood pressure < or = 90 mm Hg). Next, logistic regression was used to control for effects of age, sex, mechanism, ISS, head, chest, and abdominal injuries, BP, Glasgow Coma Scale score, and BD, with survival as the dependent and HT as the predictor variable. RESULTS: Although HT was more common in more seriously injured patients, stratified analysis revealed that hypothermic patients have significantly higher mortality than patients with the same severity of injury who remain NT. Even after controlling for injury severity and the other potential confounders listed above, HT remained a strong, independent predictor of mortality (odds ratio, 1.19; 95% confidence interval, 1.05-1.35). CONCLUSION: There is no apparent protective effect of HT in trauma patients. HT itself, not just its association with shock, injury severity, and other cofactors lead to a significant increase in mortality in injured patients. Continued, aggressive efforts to prevent and treat HT are warranted.
BACKGROUND: Successful application of induced hypothermia (HT) after stroke and cardiac arrest has led to a resurgence of interest in its potential protective effects in traumapatients. Although clinical studies demonstrate an adverse effect, they consist of small studies from single institutions. We tested the hypothesis that HT is associated with improved survival in traumapatients by analyzing a large, national trauma database. METHODS: The study included all patients in the National Trauma Data Bank (1994-2002) aged 18 to 55 years old with temperature at presentation to the emergency department and base deficit (BD) recorded. Hypothermic (temperature, <35 degrees C; n = 3267) patients and patients with normothermia (temperature, > or =35 degrees C; n = 35,283) patients were compared. Two analyses were conducted to control for the association between HT and injury severity. First, hypothermic and normothermic (NT) patients were stratified by injury severity score (ISS) and shock (blood pressure < or = 90 mm Hg). Next, logistic regression was used to control for effects of age, sex, mechanism, ISS, head, chest, and abdominal injuries, BP, Glasgow Coma Scale score, and BD, with survival as the dependent and HT as the predictor variable. RESULTS: Although HT was more common in more seriously injured patients, stratified analysis revealed that hypothermicpatients have significantly higher mortality than patients with the same severity of injury who remain NT. Even after controlling for injury severity and the other potential confounders listed above, HT remained a strong, independent predictor of mortality (odds ratio, 1.19; 95% confidence interval, 1.05-1.35). CONCLUSION: There is no apparent protective effect of HT in traumapatients. HT itself, not just its association with shock, injury severity, and other cofactors lead to a significant increase in mortality in injured patients. Continued, aggressive efforts to prevent and treat HT are warranted.
Authors: Beth Lute; William Jou; Dalya M Lateef; Margalit Goldgof; Cuiying Xiao; Ramón A Piñol; Alexxai V Kravitz; Nicole R Miller; Yuning George Huang; Clemence Girardet; Andrew A Butler; Oksana Gavrilova; Marc L Reitman Journal: Cell Metab Date: 2014-06-26 Impact factor: 27.287
Authors: Marcel Winkelmann; Jan-Dierk Clausen; Pascal Graeff; Christian Schröter; Christian Zeckey; Sanjay Weber-Spickschen; Philipp Mommsen Journal: In Vivo Date: 2019 Sep-Oct Impact factor: 2.155
Authors: Joshua B Gaither; Vatsal Chikani; Uwe Stolz; Chad Viscusi; Kurt Denninghoff; Bruce Barnhart; Terry Mullins; Amber D Rice; Moses Mhayamaguru; Jennifer J Smith; Samuel M Keim; Bentley J Bobrow; Daniel W Spaite Journal: Prehosp Emerg Care Date: 2017-05-08 Impact factor: 3.077
Authors: Kenji Inaba; Pedro G R Teixeira; Peter Rhee; Carlos Brown; Ali Salim; Joseph DuBose; Linda S Chan; Demetrios Demetriades Journal: World J Surg Date: 2009-04 Impact factor: 3.352