Petrone Patrizio, Marini Corrado P, Miller Ivan, Brathwaite Collin E M, Howell Raelina S, Cochrane Dennis, Rodríguez-Velandia Wilson, Rahn Candela, Allegra John R
Department of Surgery, NYU Langone Health - NYU Winthrop Hospital, NYU Long Island School of Medicine; Mineola, New York, USA.
Department of Surgery, Jacobi Medical Center; Albert Einstein College of Medicine; Bronx, New York, USA.
Ann Med Surg (Lond). 2020 May 6;55:81-83. doi: 10.1016/j.amsu.2020.04.018. eCollection 2020 Jul.
Frequently it is difficult to determine illness severity in hypothermic patients. Our goal was to determine if there are factors associated with illness severity of hypothermic emergency department (ED) patients.
Multi-hospital retrospective cohort. Consecutive patients in 24 EDs (1-1-2012 to 4-30-2015). Hypothermic patients (≤35 °C) were identified using ICD codes. We used hospital admission as marker of illness severity. Student's t-test was used for differences between mean age and temperature for admitted and discharged patients. We calculated the percent of patients admitted by factor, the difference from overall admission rate and 95% confidence interval (CI) of difference.
There were 2094 visits with hypothermia ICD code. Of these, 132 patients had initial rectal temperatures ≤35 °C. Females comprised 42%; the mean age was 55 ± 23 years, and overall admission rate was 62%. The percent of patients with alcohol, trauma and found indoors were 39%, 27% and 27%, respectively. For admitted and discharged patients the mean ages were 60 and 48 years, respectively (p = 0.01), and initial mean temperature 32.3 °C vs. 33 °C, respectively (p = 0.07). Found indoors was associated with an 86% admission rate, a 22% increase (95% CI, 3%-34%) compared to overall admission rate. There was no statistically significant difference in admission rates from overall admission rate based on gender, alcohol or trauma.
For hypothermic ED patients increased severity of illness was associated with older age and found indoors but not associated with initial temperature, gender, alcohol or trauma. These findings may assist physicians in treatment and disposition decisions.
低温患者的病情严重程度常常难以确定。我们的目标是确定是否存在与低温急诊科（ED）患者病情严重程度相关的因素。
多医院回顾性队列研究。连续纳入24个急诊科（2012年1月1日至2015年4月30日）的患者。使用国际疾病分类（ICD）编码识别低温患者（体温≤35°C）。我们将住院作为病情严重程度的指标。采用学生t检验比较入院患者和出院患者的平均年龄及体温差异。我们计算了按因素划分的入院患者百分比、与总体入院率的差异以及差异的95%置信区间（CI）。
有2094次就诊使用了低温ICD编码。其中，132例患者初始直肠温度≤35°C。女性占42%；平均年龄为55±23岁，总体入院率为62%。有酒精相关问题、创伤以及在室内被发现的患者百分比分别为39%、27%和27%。入院患者和出院患者的平均年龄分别为60岁和48岁（p = 0.01），初始平均体温分别为32.3°C和33°C（p = 0.07）。在室内被发现与86%的入院率相关，与总体入院率相比增加了22%（95% CI，3% - 34%）。基于性别、酒精或创伤因素，与总体入院率相比，入院率无统计学显著差异。
对于低温ED患者，病情严重程度增加与年龄较大以及在室内被发现有关，但与初始体温、性别、酒精或创伤无关。这些发现可能有助于医生进行治疗和处置决策。
