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 Tetsurou
Department of Emergency Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.
Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Ther Hypothermia Temp Manag. 2020 Sep;10(3):159-164. doi: 10.1089/ther.2019.0017. Epub 2019 Jul 18.
The impact of the location where accidental hypothermia (AH) occurs has not been fully investigated thus far. This was a multicenter retrospective study of patients with a body temperature ≤35°C obtained at the emergency department of 12 hospitals in Japan between April 2011 and March 2016. We divided the patients into two groups according to the location where AH occurred (indoor group versus outdoor group). The association between each location of the occurrence of AH and in-hospital mortality was evaluated via a multivariable logistic regression analysis. The primary outcome of this study was in-hospital death. The secondary outcomes were the lengths of ICU and hospital stay. A total of 572 patients were enrolled in the hypothermia database, and 537 patients were included in the analyses. A total of 119 and 418 patients experienced hypothermia with outdoor and indoor occurrence, respectively. The indoor group was older and had worse activities of daily living compared with the outdoor group. With regard to the outcome, the proportion of in-hospital death was higher in the indoor group than in the outdoor group (28.2% [118/418] vs. 10.9% [13/119], < 0.001). The multivariable logistic regression analysis showed that the adjusted odds ratio of the indoor group was 2.48 (95% confidence interval, 1.18-5.17). In terms of secondary outcomes, both the lengths of ICU and hospital stay of the survivors were longer in the indoor group than in the outdoor group. Hypothermia with indoor occurrence accounts for ∼78% of the total AH cases in this study, and the proportion of in-hospital deaths was higher in the indoor group than in the outdoor group. Warnings about the indoor onset of AH must be provided, and countermeasures for the prevention and early recognition of AH with indoor occurrence must be taken.
迄今为止，意外低温（AH）发生地点的影响尚未得到充分研究。这是一项多中心回顾性研究，研究对象为2011年4月至2016年3月期间在日本12家医院急诊科测得体温≤35°C的患者。我们根据AH发生的地点将患者分为两组（室内组与室外组）。通过多变量逻辑回归分析评估AH发生的每个地点与院内死亡率之间的关联。本研究的主要结局是院内死亡。次要结局是重症监护病房（ICU）住院时间和住院总时长。共有572例患者纳入低温数据库，537例患者纳入分析。分别有119例和418例患者在室外和室内发生低温。与室外组相比，室内组患者年龄更大，日常生活活动能力更差。在结局方面，室内组的院内死亡比例高于室外组（28.2%[118/418]对10.9%[13/119]，P＜0.001）。多变量逻辑回归分析显示，室内组的调整优势比为2.48（95%置信区间，1.18 - 5.17）。在次要结局方面，室内组幸存者的ICU住院时间和住院总时长均长于室外组。本研究中，室内发生的低温约占AH总病例的78%，室内组的院内死亡比例高于室外组。必须针对室内发生AH发出警告，并采取预防和早期识别室内发生AH的对策。
