Cargando…

Care at critical care medical centers is associated with improved outcomes in patients with accidental hypothermia: a historical cohort study from the J‐Point registry

AIM: The recommendation that patients with accidental hypothermia should be transported to specialized centers that can provide extracorporeal life support has not been validated, and the efficacy remains unclear. METHODS: This was a multicenter retrospective cohort study of patients with a body tem...

Descripción completa

Detalles Bibliográficos
Autores principales: Fujimoto, Yoshihiro, Matsuyama, Tasuku, Morita, Sachiko, Ehara, Naoki, Miyamae, Nobuhiro, Okada, Yohei, Jo, Takaaki, Sumida, Yasuyuki, Okada, Nobunaga, Watanabe, Makoto, Nozawa, Masahiro, Tsuruoka, Ayumu, Okumura, Yoshiki, Kitamura, Tetsuhisa, Takegami, Tetsuro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590663/
https://www.ncbi.nlm.nih.gov/pubmed/33133614
http://dx.doi.org/10.1002/ams2.578
_version_ 1783600848072343552
author Fujimoto, Yoshihiro
Matsuyama, Tasuku
Morita, Sachiko
Ehara, Naoki
Miyamae, Nobuhiro
Okada, Yohei
Jo, Takaaki
Sumida, Yasuyuki
Okada, Nobunaga
Watanabe, Makoto
Nozawa, Masahiro
Tsuruoka, Ayumu
Okumura, Yoshiki
Kitamura, Tetsuhisa
Takegami, Tetsuro
author_facet Fujimoto, Yoshihiro
Matsuyama, Tasuku
Morita, Sachiko
Ehara, Naoki
Miyamae, Nobuhiro
Okada, Yohei
Jo, Takaaki
Sumida, Yasuyuki
Okada, Nobunaga
Watanabe, Makoto
Nozawa, Masahiro
Tsuruoka, Ayumu
Okumura, Yoshiki
Kitamura, Tetsuhisa
Takegami, Tetsuro
author_sort Fujimoto, Yoshihiro
collection PubMed
description AIM: The recommendation that patients with accidental hypothermia should be transported to specialized centers that can provide extracorporeal life support has not been validated, and the efficacy remains unclear. METHODS: This was a multicenter retrospective cohort study of patients with a body temperature of ≤35°C presenting at the emergency department of 12 hospitals in Japan between April 2011 and March 2016. We divided the patients into two groups based on the point of care delivery: critical care medical center (CCMC) or non‐CCMC. The primary outcome of this study was in‐hospital death. In‐hospital death was compared using a multivariable logistic regression analysis. Subgroup analyses were carried out according to patients with severe hypothermia (<28°C) or systolic blood pressure (sBP) of <90 mmHg. RESULTS: A total of 537 patients were included, 413 patients (76.9%) in the CCMC group and 124 patients (23.1%) in the non‐CCMC group. The in‐hospital death rate was lower in the CCMC group than in the non‐CCMC group (22.3% versus 31.5%, P < 0.001). The multivariable logistic regression analysis showed that the adjusted odds ratio (AOR) of the CCMC group was 0.54 (95% confidence interval, 0.32–0.90). In subgroup analyses, patients with systolic blood pressure <90 mmHg in the CCMC group were less likely to experience in‐hospital death (AOR 0.36; 95% CI, 0.23–0.56). However, no such association was observed among patients with severe hypothermia (AOR 1.08; 95% CI, 0.63–1.85). CONCLUSIONS: Our multicenter study indicated that care at a CCMC was associated with improved outcomes in patients with accidental hypothermia.
format Online
Article
Text
id pubmed-7590663
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-75906632020-10-30 Care at critical care medical centers is associated with improved outcomes in patients with accidental hypothermia: a historical cohort study from the J‐Point registry Fujimoto, Yoshihiro Matsuyama, Tasuku Morita, Sachiko Ehara, Naoki Miyamae, Nobuhiro Okada, Yohei Jo, Takaaki Sumida, Yasuyuki Okada, Nobunaga Watanabe, Makoto Nozawa, Masahiro Tsuruoka, Ayumu Okumura, Yoshiki Kitamura, Tetsuhisa Takegami, Tetsuro Acute Med Surg Original Articles AIM: The recommendation that patients with accidental hypothermia should be transported to specialized centers that can provide extracorporeal life support has not been validated, and the efficacy remains unclear. METHODS: This was a multicenter retrospective cohort study of patients with a body temperature of ≤35°C presenting at the emergency department of 12 hospitals in Japan between April 2011 and March 2016. We divided the patients into two groups based on the point of care delivery: critical care medical center (CCMC) or non‐CCMC. The primary outcome of this study was in‐hospital death. In‐hospital death was compared using a multivariable logistic regression analysis. Subgroup analyses were carried out according to patients with severe hypothermia (<28°C) or systolic blood pressure (sBP) of <90 mmHg. RESULTS: A total of 537 patients were included, 413 patients (76.9%) in the CCMC group and 124 patients (23.1%) in the non‐CCMC group. The in‐hospital death rate was lower in the CCMC group than in the non‐CCMC group (22.3% versus 31.5%, P < 0.001). The multivariable logistic regression analysis showed that the adjusted odds ratio (AOR) of the CCMC group was 0.54 (95% confidence interval, 0.32–0.90). In subgroup analyses, patients with systolic blood pressure <90 mmHg in the CCMC group were less likely to experience in‐hospital death (AOR 0.36; 95% CI, 0.23–0.56). However, no such association was observed among patients with severe hypothermia (AOR 1.08; 95% CI, 0.63–1.85). CONCLUSIONS: Our multicenter study indicated that care at a CCMC was associated with improved outcomes in patients with accidental hypothermia. John Wiley and Sons Inc. 2020-10-27 /pmc/articles/PMC7590663/ /pubmed/33133614 http://dx.doi.org/10.1002/ams2.578 Text en © 2020 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Fujimoto, Yoshihiro
Matsuyama, Tasuku
Morita, Sachiko
Ehara, Naoki
Miyamae, Nobuhiro
Okada, Yohei
Jo, Takaaki
Sumida, Yasuyuki
Okada, Nobunaga
Watanabe, Makoto
Nozawa, Masahiro
Tsuruoka, Ayumu
Okumura, Yoshiki
Kitamura, Tetsuhisa
Takegami, Tetsuro
Care at critical care medical centers is associated with improved outcomes in patients with accidental hypothermia: a historical cohort study from the J‐Point registry
title Care at critical care medical centers is associated with improved outcomes in patients with accidental hypothermia: a historical cohort study from the J‐Point registry
title_full Care at critical care medical centers is associated with improved outcomes in patients with accidental hypothermia: a historical cohort study from the J‐Point registry
title_fullStr Care at critical care medical centers is associated with improved outcomes in patients with accidental hypothermia: a historical cohort study from the J‐Point registry
title_full_unstemmed Care at critical care medical centers is associated with improved outcomes in patients with accidental hypothermia: a historical cohort study from the J‐Point registry
title_short Care at critical care medical centers is associated with improved outcomes in patients with accidental hypothermia: a historical cohort study from the J‐Point registry
title_sort care at critical care medical centers is associated with improved outcomes in patients with accidental hypothermia: a historical cohort study from the j‐point registry
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590663/
https://www.ncbi.nlm.nih.gov/pubmed/33133614
http://dx.doi.org/10.1002/ams2.578
work_keys_str_mv AT fujimotoyoshihiro careatcriticalcaremedicalcentersisassociatedwithimprovedoutcomesinpatientswithaccidentalhypothermiaahistoricalcohortstudyfromthejpointregistry
AT matsuyamatasuku careatcriticalcaremedicalcentersisassociatedwithimprovedoutcomesinpatientswithaccidentalhypothermiaahistoricalcohortstudyfromthejpointregistry
AT moritasachiko careatcriticalcaremedicalcentersisassociatedwithimprovedoutcomesinpatientswithaccidentalhypothermiaahistoricalcohortstudyfromthejpointregistry
AT eharanaoki careatcriticalcaremedicalcentersisassociatedwithimprovedoutcomesinpatientswithaccidentalhypothermiaahistoricalcohortstudyfromthejpointregistry
AT miyamaenobuhiro careatcriticalcaremedicalcentersisassociatedwithimprovedoutcomesinpatientswithaccidentalhypothermiaahistoricalcohortstudyfromthejpointregistry
AT okadayohei careatcriticalcaremedicalcentersisassociatedwithimprovedoutcomesinpatientswithaccidentalhypothermiaahistoricalcohortstudyfromthejpointregistry
AT jotakaaki careatcriticalcaremedicalcentersisassociatedwithimprovedoutcomesinpatientswithaccidentalhypothermiaahistoricalcohortstudyfromthejpointregistry
AT sumidayasuyuki careatcriticalcaremedicalcentersisassociatedwithimprovedoutcomesinpatientswithaccidentalhypothermiaahistoricalcohortstudyfromthejpointregistry
AT okadanobunaga careatcriticalcaremedicalcentersisassociatedwithimprovedoutcomesinpatientswithaccidentalhypothermiaahistoricalcohortstudyfromthejpointregistry
AT watanabemakoto careatcriticalcaremedicalcentersisassociatedwithimprovedoutcomesinpatientswithaccidentalhypothermiaahistoricalcohortstudyfromthejpointregistry
AT nozawamasahiro careatcriticalcaremedicalcentersisassociatedwithimprovedoutcomesinpatientswithaccidentalhypothermiaahistoricalcohortstudyfromthejpointregistry
AT tsuruokaayumu careatcriticalcaremedicalcentersisassociatedwithimprovedoutcomesinpatientswithaccidentalhypothermiaahistoricalcohortstudyfromthejpointregistry
AT okumurayoshiki careatcriticalcaremedicalcentersisassociatedwithimprovedoutcomesinpatientswithaccidentalhypothermiaahistoricalcohortstudyfromthejpointregistry
AT kitamuratetsuhisa careatcriticalcaremedicalcentersisassociatedwithimprovedoutcomesinpatientswithaccidentalhypothermiaahistoricalcohortstudyfromthejpointregistry
AT takegamitetsuro careatcriticalcaremedicalcentersisassociatedwithimprovedoutcomesinpatientswithaccidentalhypothermiaahistoricalcohortstudyfromthejpointregistry