Hypothermie et traumatisé ne font pas bon ménage

Il est parfaitement démontré que l'hypothermie aggrave le pronostic vital des polytraumatisés. C'est un facteur indépendant de mortalité. Cette nouvelle publication le confirme. Elle précise par ailleurs que le risque d'hypothermie est accrue par un transport héliporté.

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The incidence and significance of accidental hypothermia in major trauma—A prospective observational study

Ireland S et all.

Resuscitation 82 (2011) 300–306

Background

 

Serious sequelae have been associated with injured patients who are hypothermic (<35 °C) including coagulopathy, acidosis, decreased myocardial contractility and risk of mortality.

Aim

 

Establish the incidence of accidental hypothermia in major trauma patients and identify causative factors.

Method

 

Prospective identification and subsequent review of 732 medical records of major trauma patients presenting to an Adult Major Trauma Centre was undertaken between January and December 2008. Multivariate analysis was performed using logistic regression. Significant and clinically relevant variables from univariate analysis were entered into multivariate models to evaluate determinants for hypothermia and for death. Goodness of fit was determined with the use of the Hosmer–Lemeshow statistic.

Main results

 

Overall mortality was 9.15%. The incidence of hypothermia was 13.25%. The mortality of patients with hypothermia was 29.9% with a threefold independent risk of death: OR (CI 95%) 3.44 (1.48–7.99), P = 0.04. Independent determinants for hypothermia were pre-hospital intubation: OR (CI 95%) 5.18 (2.77–9.71), P < 0.001, Injury Severity Score (ISS): 1.04 (1.01–1.06), P = 0.01, Arrival Systolic Blood Pressure (ASBP) < 100 mm Hg: 3.04 (1.24–7.44), P = 0.02, and wintertime: 1.84 (1.06–3.21), P = 0.03.

 

Of the 87 hypothermic patients who had repeat temperatures recorded in the Emergency Department, 77 (88.51%) patients had a temperature greater than the recorded arrival temperature. There was no change in recorded temperature for four (4.60%) patients, whereas six (6.90%) patients were colder at Emergency Department discharge.

Conclusion

 

Seriously injured patients with accidental hypothermia have a higher mortality independent of measured risk factors. For patients with multiple injuries a coordinated effort by paramedics, nurses and doctors is required to focus efforts toward early resolution of hypothermia aiming to achieve a temperature >35 °C.