TY - JOUR
T1 - An analysis of the incidence of hypothermia in casualties presenting to emergency departments in Iraq and Afghanistan
AU - Fisher, Andrew D.
AU - April, Michael D.
AU - Schauer, Steven G.
N1 - Funding Information:
We would like to thank the Joint Trauma System Data Analysis Branch for their efforts with data acquisition. Opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Air Force, the Department of the Army, or the Department of Defense. The USAISR regulatory office reviewed protocol H-16-005 and determined it was exempt from IRB oversight. We obtained only de-identified data.
Publisher Copyright:
© 2019
PY - 2020/11
Y1 - 2020/11
N2 - Introduction: Hypothermia on the battlefield has been shown to be associated with severe injury and higher mortality. The incidence of battlefield casualties presenting with hypothermia are described. Methods: The Department of Defense Trauma Registry (DoDTR) was queried from January 2007 to August 2016. We identified casualties with a documented temperature of <32°Celsius (C) (severe), 32–33.9 °C (moderate), 34–36 °C (mild). We defined serious injuries as those resulting in an AIS of ≥3 by body region. Results: There were 25,484 records with at least one documented temperature and 2501 (9.8%) casualties with hypothermia within our range. Nineteen (0.75%) casualties presented with severe hypothermia, 225 (9%) with moderate, and 2257 (90%) with mild. The mean injury severity score (ISS) for non-hypothermic, mild, moderate, and severe hypothermic casualties was 8 [4–14], 14 [6–24], 21 [13–29], and 21 [9–25], (p <0.001), respectively. Survival for casualties with severe hypothermia was 57.8%, moderate 80.9%, mild hypothermia 90.9%, and non-hypothermic group 97.6%, p<0.001. When adjusting for composite injury score, patient category, mechanism of injury, and location, this finding remained significant (OR 0.27, 0.21–0.34, p<0.001). Massive transfusion was more common in hypothermia casualties n = 566 (19%) versus non-hypothermic recipients n = 1734 (6.9%), p <0.001. Conclusions: Though the number of casualties that presented hypothermic was small, their injuries were more severe, and were more likely to receive massive blood transfusions. This cohort also had a higher mortality rate, a finding which held when adjusting for confounders. There appears to be an opportunity to improve hypothermia prevention for combat.
AB - Introduction: Hypothermia on the battlefield has been shown to be associated with severe injury and higher mortality. The incidence of battlefield casualties presenting with hypothermia are described. Methods: The Department of Defense Trauma Registry (DoDTR) was queried from January 2007 to August 2016. We identified casualties with a documented temperature of <32°Celsius (C) (severe), 32–33.9 °C (moderate), 34–36 °C (mild). We defined serious injuries as those resulting in an AIS of ≥3 by body region. Results: There were 25,484 records with at least one documented temperature and 2501 (9.8%) casualties with hypothermia within our range. Nineteen (0.75%) casualties presented with severe hypothermia, 225 (9%) with moderate, and 2257 (90%) with mild. The mean injury severity score (ISS) for non-hypothermic, mild, moderate, and severe hypothermic casualties was 8 [4–14], 14 [6–24], 21 [13–29], and 21 [9–25], (p <0.001), respectively. Survival for casualties with severe hypothermia was 57.8%, moderate 80.9%, mild hypothermia 90.9%, and non-hypothermic group 97.6%, p<0.001. When adjusting for composite injury score, patient category, mechanism of injury, and location, this finding remained significant (OR 0.27, 0.21–0.34, p<0.001). Massive transfusion was more common in hypothermia casualties n = 566 (19%) versus non-hypothermic recipients n = 1734 (6.9%), p <0.001. Conclusions: Though the number of casualties that presented hypothermic was small, their injuries were more severe, and were more likely to receive massive blood transfusions. This cohort also had a higher mortality rate, a finding which held when adjusting for confounders. There appears to be an opportunity to improve hypothermia prevention for combat.
KW - Casualty
KW - Cold
KW - Combat
KW - Hypothermia
KW - Military
KW - Trauma
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U2 - 10.1016/j.ajem.2019.11.050
DO - 10.1016/j.ajem.2019.11.050
M3 - Article
C2 - 31859193
AN - SCOPUS:85076834221
VL - 38
SP - 2343
EP - 2346
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
SN - 0735-6757
IS - 11
ER -