Hostler David, Weaver Matthew D, Ziembicki Jenny A, Kowger Heather L, McEntire Serina J, Rittenberger Jon C, Callaway Clifton W, Patterson P Daniel, Corcos Alain C
From the *Department of Emergency Medicine, Emergency Responder Human Performance Lab, University of Pittsburgh, Pittsburgh, Pennsylvania; and †Department of Surgery, UPMC Mercy Trauma and Burn Center, Pittsburgh, Pennsylvania.
J Burn Care Res. 2013 Sep-Oct;34(5):498-506. doi: 10.1097/BCR.0b013e3182a231fb.
It is commonly believed that hypothermia occurring during burn resuscitation is associated with poor outcome, but there is little direct supporting evidence. The authors conducted an analysis of a statewide trauma registry to determine whether hypothermia (T ≤36.5°C) was associated with mortality when controlling for clinical confounders. They included all patients treated at an accredited burn center from 2000 to 2011 where the trauma registrar recorded the primary injury type as a burn. They excluded records with missing data and nonphysiologic temperature (<26°C or >42°C). The primary exposure of interest was hypothermia. The authors constructed a hierarchical, multivariable logistic regression model to examine the effect of hypothermia on survival, controlling for potentially confounding variables. Predictors of mortality are presented as odds ratio (95% confidence interval). Primary burn injury was coded 17,098 times during the study period. Of these, 3809 were not treated at a burn center and 1192 were excluded for missing data. Admission hypothermia was independently associated with mortality (1.91 [1.58-2.29]) when adjusting for age, sex, total second- and third-degree burn surface area (TBSA), comorbid conditions, injury severity score, direct transport vs referral, method of temperature measurement, year, and the hospital providing care. Increasing age, female sex, TBSA >40%, presence of multiple comorbid conditions, and increasing injury severity score were associated with mortality. Other variables in the model were not independently associated with outcome. There was a weak correlation between TBSA and admission temperature (r = .18). Hypothermia at hospital admission is independently associated with mortality in burn patients when controlling for clinical confounders. Future studies should address potential causes underlying this observation.
人们普遍认为，烧伤复苏期间发生的体温过低与预后不良有关，但几乎没有直接的支持证据。作者对全州创伤登记处进行了分析，以确定在控制临床混杂因素时，体温过低（T≤36.5°C）是否与死亡率相关。他们纳入了2000年至2011年在一家认可的烧伤中心接受治疗的所有患者，创伤登记员将其主要损伤类型记录为烧伤。他们排除了数据缺失和体温异常（<26°C或>42°C）的记录。主要关注的暴露因素是体温过低。作者构建了一个分层多变量逻辑回归模型，以检验体温过低对生存的影响，并控制潜在的混杂变量。死亡率预测因素以比值比（95%置信区间）表示。在研究期间，原发性烧伤损伤被编码17098次。其中，3809例未在烧伤中心接受治疗，1192例因数据缺失被排除。在调整年龄、性别、二度和三度烧伤总面积（TBSA）、合并症、损伤严重程度评分、直接转运与转诊、体温测量方法、年份以及提供治疗的医院后，入院时体温过低与死亡率独立相关（1.91[1.58 - 2.29]）。年龄增加、女性、TBSA>40%、存在多种合并症以及损伤严重程度评分增加与死亡率相关。模型中的其他变量与预后无独立相关性。TBSA与入院体温之间存在弱相关性（r = 0.18）。在控制临床混杂因素时，烧伤患者入院时体温过低与死亡率独立相关。未来的研究应探讨这一观察结果背后的潜在原因。
