Emergency Department, Lausanne University Hospital, and University of Lausanne, BH 09, CHUV, 1011, Lausanne, Switzerland.
Medical School of the University of Lausanne, Bugnon 21, 1011, Lausanne, Switzerland.
Scand J Trauma Resusc Emerg Med. 2019 Jun 6;27(1):60. doi: 10.1186/s13049-019-0636-0.
The Swiss staging model for hypothermia uses clinical indicators to stage hypothermia and guide the management of hypothermic patients. The proposed temperature range for clinical stage 1 is < 35-32 °C, for stage 2 is < 32-28 °C, for stage 3 is < 28-24 °C, and for stage 4 is below 24 °C. Our previous study using 183 case reports from the literature showed that the measured temperature only corresponded to the clinical stage in the Swiss staging model in approximately 50% of cases. This study, however, included few patients with moderate hypothermia. We aimed to expand this database by adding cases of hypothermic patients admitted to hospital to perform a more comprehensive evaluation of the staging model.
We retrospectively included patients aged ≥18 y admitted to hospital between 1.1.1994 and 15.7.2016 with a core temperature below 35 °C. We added the cases identified through our previously published literature review to estimate the percentage of those patients who were correctly classified and compare the theoretical with the observed temperature ranges for each clinical stage.
We included 305 cases (122 patients from the hospital sampling and the 183 previously published). Using the theoretically derived temperature ranges for clinical stages resulted in 185/305 (61%) patients being assigned to the correct temperature range. Temperature was overestimated using the clinical stage in 55/305 cases (18%) and underestimated in 65/305 cases (21%); important overlaps in temperature existed among the four stage groups. The optimal temperature thresholds for discriminating between the four stages (32.1 °C, 27.5 °C, and 24.1 °C) were close to those proposed historically (32 °C, 28 °C, and 24 °C).
Our results provide further evidence of the relationship between the clinical state of patients and their temperature. The historical proposed temperature thresholds were almost optimal for discriminating between the different stages. Adding overlapping temperature ranges for each clinical stage might help clinicians to make appropriate decisions when using clinical signs to infer temperature. An update of the Swiss staging model for hypothermia including our methodology and findings could positively impact clinical care and future research.
瑞士低温分期模型使用临床指标对低温进行分期，并指导低温患者的管理。临床分期 1 的建议温度范围为<35-32°C，分期 2 为<32-28°C，分期 3 为<28-24°C，分期 4 为<24°C。我们之前的研究使用了文献中的 183 例病例报告，结果表明，在大约 50%的情况下，测量的温度仅与瑞士分期模型中的临床分期相对应。然而，这项研究中中度低温的患者较少。我们旨在通过增加住院低温患者的病例来扩展该数据库，以便更全面地评估分期模型。
我们回顾性纳入了 1994 年 1 月 1 日至 2016 年 7 月 15 日期间住院的年龄≥18 岁且核心体温<35°C 的患者。我们将通过之前发表的文献综述确定的病例添加到研究中，以估计正确分类的患者比例，并比较每个临床分期的理论和观察到的温度范围。
我们纳入了 305 例患者（122 例来自医院采样，183 例来自之前发表的文献）。使用临床分期理论推导的温度范围，可将 185/305（61%）例患者分配到正确的温度范围。在 55/305 例（18%）患者中，体温被高估，在 65/305 例（21%）患者中被低估；四个分期组之间的体温存在重要重叠。用于区分四个分期的最佳温度阈值（32.1°C、27.5°C 和 24.1°C）与历史上提出的温度阈值（32°C、28°C 和 24°C）接近。
我们的结果提供了患者临床状态与体温之间关系的进一步证据。历史上提出的温度阈值对于区分不同阶段几乎是最优的。为每个临床阶段添加重叠的温度范围可能有助于临床医生在使用临床体征推断体温时做出适当的决策。更新包括我们的方法和发现的瑞士低温分期模型可能会对临床护理和未来的研究产生积极影响。
