Document Detail


Impact of prehospital hypothermia on transfusion requirements and outcomes.
MedLine Citation:
PMID:  23117380     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Prehospital hypothermia (PH) is known to increase mortality following traumatic injury. PH relationship with transfusion requirements has not been documented. The purpose of this investigation was to analyze the impact of PH on blood product requirements and subsequent outcomes.
METHODS: The Los Angeles County Trauma System Database was queried for all patients admitted between 2005 and 2009. Demographics, physiologic parameters, and transfusion requirements were obtained and dichotomized by admission temperatures with a core temperature of less than 36.5 °C considered hypothermic. Multivariate analysis was performed to determine factors contributing to transfusion requirements and to derive adjusted odds ratios (AORs) for mortality and rates of adult respiratory distress syndrome and pneumonia.
RESULTS: A total of 21,023 patients were analyzed in our study with 44.6% presenting with PH. Hypothermic patients required 26% more fluid resuscitation (p < 0.001) in the emergency department and 17% more total blood products (p < 0.001) than those who were admitted with a normal temperature. There was a trend toward an increase in emergency department transfusion (8%, p = 0.06). PH was independently associated with the need for a transfusion (AOR, 1.1; p = 0.047), increased mortality (AOR, 2.0; p < 0.01), as well as incidence of adult respiratory distress syndrome (AOR, 1.8; p < 0.05) and pneumonia (AOR, 2.6; p < 0.01).
CONCLUSION: PH is associated with increased transfusion and fluid requirements and subsequently worse outcomes. Interventions that correct hypothermia may decrease transfusion requirements and improve outcomes. Prospective studies investigating correction of hypothermia in trauma patients are warranted.
LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III.
Authors:
Marko Bukur; Anoushiravan Amini Hadjibashi; Eric J Ley; Darren Malinoski; Matthew Singer; Galinos Barmparas; Daniel Margulies; Ali Salim
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  73     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-02     Completed Date:  2013-02-11     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1195-201     Citation Subset:  AIM; IM    
Affiliation:
Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. bukurm@cshs.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Transfusion*
Brain Injuries / complications*,  mortality,  therapy*
Female
Hospitalization*
Humans
Hypothermia / complications*,  mortality,  therapy*
Male
Middle Aged
Pneumonia / epidemiology
Respiratory Distress Syndrome, Adult / epidemiology
Retrospective Studies
Survival Rate
Trauma Centers
Treatment Outcome
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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