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Prognostic factors for patients with accidental hypothermia: A multi-institutional retrospective cohort study
Yohei Okada1, Tasuku Matsuyama2, Sachiko Morita3
1Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Red Cross Hospital, Japan.
Insights
Severe accidental hypothermia (AH) in urban settings has unknown prognostic factors. Key mortality predictors include advanced age, ADL dependency, hemodynamic instability, and hyperkalemia.
Area of Science:
- Emergency Medicine
- Critical Care
- Environmental Health
Background:
- Prognostic factors for severe accidental hypothermia (AH) in urban environments are not well-established.
- Understanding these factors is crucial for improving patient outcomes in emergency settings.
Purpose of the Study:
- To identify prognostic factors associated with in-hospital mortality in patients with moderate-to-severe AH in urban Japan.
- To inform clinical decision-making and resource allocation for AH patients.
Main Methods:
- Retrospective cohort study utilizing the J-Point registry database from 12 Japanese emergency departments.
- Inclusion criteria: patients with core body temperature ≤ 32°C on admission.
- Multivariate logistic regression analysis was used to determine adjusted odds ratios (AORs) and 95% confidence intervals (CI) for in-hospital death.
Main Results:
- Analysis included 358 patients with a median body temperature of 29.2°C; 26.3% experienced in-hospital death.
- Independent predictors of mortality were: age ≥ 75 years (AOR, 3.09), need for assistance with activities of daily living (ADL) (AOR, 3.06), hemodynamic instability (AOR, 2.49), and hyperkalemia (≥ 5.6 mEq/L) (AOR, 2.65).
Conclusions:
- Age ≥ 75 years, ADL dependency, hemodynamic instability, and hyperkalemia are significant independent prognostic factors for in-hospital mortality in urban AH cases.
- These findings highlight critical patient characteristics that require close monitoring and prompt intervention in emergency departments.
Introduction:
In cases of severe accidental hypothermia (AH) in urban areas, the prognostic factors are unknown. We identified factors associated with in-hospital mortality in patients with moderate-to-severe AH in urban areas of Japan.
Method:
The J-Point registry database is a multi-institutional retrospective cohort study for AH in 12 Japanese emergency departments. From this registry, we enrolled patients whose core body temperature was 32 °C or less on admission. In-hospital death was the primary outcome of this study. We investigated the association between each candidate prognostic factor and in-hospital death by applying the multivariate logistic regression analyses with adjusted odds ratios (AORs) and their 95% confidence interval [CI] as the effect variables.
Results:
Of 572 patients registered in the J-point registry, 358 hypothermic patients were eligible for analyses. Median body temperature was 29.2 °C (interquartile range, 27.0 °C-30.8 °C). In-hospital deaths comprised 26.3% (94/358) of all study patients. Factors associated with in-hospital death were age ≥ 75 years (AOR, 3.09; 95% CI, 1.31-7.27), need for assistance with activities of daily living (ADL; AOR, 3.06; 95% CI, 1.68-5.59), hemodynamic instability (AOR, 2.49; 95% CI, 1.32-4.68), and hyperkalemia (≥5.6 mEq/L; AOR, 2.65; 95% CI, 1.13-6.21).
Conclusion:
The independent prognostic factors associated with in-hospital mortality of patients with moderate-to-severe AH in urban areas of Japan were age ≥ 75 years, need for assistance with ADL, hemodynamic instability, and hyperkalemia.
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