Secondary hypothermia at triage as a predictor of short-term mortality: A retrospective cohort study

In Taiwan, secondary hypothermia is common in emergency departments (EDs) but is not well incorporated into triage systems. The present study explored patterns of comorbidities and clinical predictors of 30-day mortality in ED patients with secondary hypothermia to improve severity assessments and guide early triage.

This retrospective cohort study included adult patients who presented to a tertiary ED between 2019 and 2021 and had available data on tympanic temperature at triage. Patients were stratified into normothermia, mild hypothermia, and moderate hypothermia groups. Data on demographic characteristics, comorbidities, vital signs, and 30-day mortality were collected. Multivariate logistic regression with backward selection was performed to identify independent predictors of adverse outcomes.

The final cohort comprised 4891 patients. Of the patients, 11.4% and 0.4% had mild and moderate hypothermia, respectively, at presentation. Secondary hypothermia was associated with an elevated comorbidity burden, impaired consciousness, and hemodynamic instability. The risk of 30-day mortality increased with hypothermia severity; it was 1.71% in the normothermia group, 8.44% in the mild hypothermia group, and 31.58% in the moderate hypothermia group. After adjustment for age, sex, comorbidities, neurological status, and hemodynamic variables, both mild and moderate hypothermia remained independently associated with an increased risk of 30-day mortality. This association was consistent across major demographic and clinical subgroups.

In emergency care, secondary hypothermia is a crucial prognostic indicator of systemic vulnerability. Early recognition and severity-based triage may improve treatment decision-making, resource allocation, and clinical outcomes.