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Impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the J-Point registry

BACKGROUND: Accidental hypothermia (AH) is defined as an involuntary decrease in core body temperature to < 35 °C. The management of AH has been progressing over the last few decades, and numerous techniques for rewarming have been validated. However, little is known about the association between...

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Autores principales: Watanabe, Makoto, Matsuyama, Tasuku, Morita, Sachiko, Ehara, Naoki, Miyamae, Nobuyoshi, Okada, Yohei, Jo, Takaaki, Sumida, Yasuyuki, Okada, Nobunaga, Nozawa, Masahiro, Tsuruoka, Ayumu, Fujimoto, Yoshihiro, Okumura, Yoshiki, Kitamura, Tetsuhisa, Ohta, Bon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880476/
https://www.ncbi.nlm.nih.gov/pubmed/31771645
http://dx.doi.org/10.1186/s13049-019-0684-5
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author Watanabe, Makoto
Matsuyama, Tasuku
Morita, Sachiko
Ehara, Naoki
Miyamae, Nobuyoshi
Okada, Yohei
Jo, Takaaki
Sumida, Yasuyuki
Okada, Nobunaga
Nozawa, Masahiro
Tsuruoka, Ayumu
Fujimoto, Yoshihiro
Okumura, Yoshiki
Kitamura, Tetsuhisa
Ohta, Bon
author_facet Watanabe, Makoto
Matsuyama, Tasuku
Morita, Sachiko
Ehara, Naoki
Miyamae, Nobuyoshi
Okada, Yohei
Jo, Takaaki
Sumida, Yasuyuki
Okada, Nobunaga
Nozawa, Masahiro
Tsuruoka, Ayumu
Fujimoto, Yoshihiro
Okumura, Yoshiki
Kitamura, Tetsuhisa
Ohta, Bon
author_sort Watanabe, Makoto
collection PubMed
description BACKGROUND: Accidental hypothermia (AH) is defined as an involuntary decrease in core body temperature to < 35 °C. The management of AH has been progressing over the last few decades, and numerous techniques for rewarming have been validated. However, little is known about the association between rewarming rate (RR) and mortality in patients with AH. METHOD: This was a multicentre chart review study of patients with AH visiting the emergency department of 12 institutions in Japan from April 2011 to March 2016 (Japanese accidental hypothermia network registry, J-Point registry). We retrospectively registered patients using the International Classification of Diseases, Tenth Revision code T68: ‘hypothermia’. We excluded patients whose body temperatures were unknown or ≥ 35 °C, who could not be rewarmed, whose rewarmed temperature or rewarming time was unknown, those aged < 18 years, or who or whose family members had refused to join the registry. RR was calculated based on the body temperature on arrival at the hospital, time of arrival at the hospital, the documented temperature during rewarming, and time of the temperature documentation. RR was classified into the following five groups: ≥2.0 °C/h, 1.5–< 2.0 °C/h, 1.0–< 1.5 °C/h, 0.5–< 1.0 °C/h, and < 0.5 °C/h. The primary outcome of this study was in-hospital mortality. The association between RR and in-hospital mortality was evaluated using multivariate logistic regression analysis. RESULT: During the study, 572 patients were registered in the J-Point registry, and 481 patients were included in the analysis. The median body temperature on arrival to the hospital was 30.7 °C (interquartile range [IQR], 28.2 °C–32.4 °C), and the median RR was 0.85 °C/h (IQR, 0.53 °C/h–1.31 °C/h). The in-hospital mortality rates were 19.3% (11/57), 11.1% (4/36), 14.4% (15/104), 20.1% (35/175), and 34.9% (38/109) in the ≥2.0 °C/h, 1.5–< 2.0 °C/h, 1.0–< 1.5 °C/h, 0.5–< 1.0 °C/h, and < 0.5 °C/h groups, respectively. Multivariate regression analysis revealed that in-hospital mortality rate increased with each 0.5 °C/h decrease in RR (adjusted odds ratio, 1.49; 95% confidence interval, 1.15–1.94; P(trend) < 0.01). CONCLUSION: This study showed that slower RR is independently associated with in-hospital mortality.
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spelling pubmed-68804762019-11-29 Impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the J-Point registry Watanabe, Makoto Matsuyama, Tasuku Morita, Sachiko Ehara, Naoki Miyamae, Nobuyoshi Okada, Yohei Jo, Takaaki Sumida, Yasuyuki Okada, Nobunaga Nozawa, Masahiro Tsuruoka, Ayumu Fujimoto, Yoshihiro Okumura, Yoshiki Kitamura, Tetsuhisa Ohta, Bon Scand J Trauma Resusc Emerg Med Original Research BACKGROUND: Accidental hypothermia (AH) is defined as an involuntary decrease in core body temperature to < 35 °C. The management of AH has been progressing over the last few decades, and numerous techniques for rewarming have been validated. However, little is known about the association between rewarming rate (RR) and mortality in patients with AH. METHOD: This was a multicentre chart review study of patients with AH visiting the emergency department of 12 institutions in Japan from April 2011 to March 2016 (Japanese accidental hypothermia network registry, J-Point registry). We retrospectively registered patients using the International Classification of Diseases, Tenth Revision code T68: ‘hypothermia’. We excluded patients whose body temperatures were unknown or ≥ 35 °C, who could not be rewarmed, whose rewarmed temperature or rewarming time was unknown, those aged < 18 years, or who or whose family members had refused to join the registry. RR was calculated based on the body temperature on arrival at the hospital, time of arrival at the hospital, the documented temperature during rewarming, and time of the temperature documentation. RR was classified into the following five groups: ≥2.0 °C/h, 1.5–< 2.0 °C/h, 1.0–< 1.5 °C/h, 0.5–< 1.0 °C/h, and < 0.5 °C/h. The primary outcome of this study was in-hospital mortality. The association between RR and in-hospital mortality was evaluated using multivariate logistic regression analysis. RESULT: During the study, 572 patients were registered in the J-Point registry, and 481 patients were included in the analysis. The median body temperature on arrival to the hospital was 30.7 °C (interquartile range [IQR], 28.2 °C–32.4 °C), and the median RR was 0.85 °C/h (IQR, 0.53 °C/h–1.31 °C/h). The in-hospital mortality rates were 19.3% (11/57), 11.1% (4/36), 14.4% (15/104), 20.1% (35/175), and 34.9% (38/109) in the ≥2.0 °C/h, 1.5–< 2.0 °C/h, 1.0–< 1.5 °C/h, 0.5–< 1.0 °C/h, and < 0.5 °C/h groups, respectively. Multivariate regression analysis revealed that in-hospital mortality rate increased with each 0.5 °C/h decrease in RR (adjusted odds ratio, 1.49; 95% confidence interval, 1.15–1.94; P(trend) < 0.01). CONCLUSION: This study showed that slower RR is independently associated with in-hospital mortality. BioMed Central 2019-11-26 /pmc/articles/PMC6880476/ /pubmed/31771645 http://dx.doi.org/10.1186/s13049-019-0684-5 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Original Research
Watanabe, Makoto
Matsuyama, Tasuku
Morita, Sachiko
Ehara, Naoki
Miyamae, Nobuyoshi
Okada, Yohei
Jo, Takaaki
Sumida, Yasuyuki
Okada, Nobunaga
Nozawa, Masahiro
Tsuruoka, Ayumu
Fujimoto, Yoshihiro
Okumura, Yoshiki
Kitamura, Tetsuhisa
Ohta, Bon
Impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the J-Point registry
title Impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the J-Point registry
title_full Impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the J-Point registry
title_fullStr Impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the J-Point registry
title_full_unstemmed Impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the J-Point registry
title_short Impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the J-Point registry
title_sort impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the j-point registry
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880476/
https://www.ncbi.nlm.nih.gov/pubmed/31771645
http://dx.doi.org/10.1186/s13049-019-0684-5
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