Department of Emergency Medicine, Asahikawa Medical University Hospital, Japan; Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.
Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Japan; Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.
Am J Emerg Med. 2021 Sep;47:169-175. doi: 10.1016/j.ajem.2021.03.079. Epub 2021 Mar 29.
The incidence of accidental hypothermia (AH) is low, and the length of hospital stay in patients with AH remains poorly understood. The present study explored which factors were related to prolonged hospitalization among patients with AH using Japan's nationwide registry data.
The data from the Hypothermia STUDY 2018, which included patients ≥18 years old with a body temperature ≤ 35 °C, were obtained from a multicenter registry for AH conducted at 89 institutions throughout Japan, collected from December 1, 2018, to February 28, 2019. The patients were divided into a "short-stay patients" group (within 7 days) and "long-stay patients" group (more than 7 days). A logistic regression analysis after multiple imputation was performed to obtain odds ratios (ORs) for prolonged hospitalization with age, frailty, location, causes underlying the hypothermia, temperature, pH, potassium level, and disseminated intravascular coagulation (DIC) score as independent variables.
In total, 656 patients were included in the study, of which 362 were eligible for the analysis. The median length of hospital stay was 17 days. Of the 362 patients, 265 (73.2%) stayed in the hospital for more than 7 days. The factors associated with prolonged hospitalization were frailty (OR, 2.11; 95% confidence interval [CI], 1.09-4.10; p = 0.027), the occurrence of indoor (OR, 3.20; 95% CI, 1.58-6.46; p = 0.001), alcohol intoxication (OR, 0.17; 95% CI, 0.05-0.56; p = 0.004), pH (OR, 0.07; 95% CI, 0.01-0.76; p = 0.029), potassium level (OR, 1.36; 95% CI, 1.00-1.85; p = 0.048), and DIC score (OR, 1.54; 95% CI, 1.13-2.10; p = 0.006).
Frailty, indoor situation, alcohol intoxication, pH value, potassium level, and DIC score were factors contributing to prolonged hospitalization in patients with AH. Preventing frailty may help reduce the length of hospital stay in patients with AH. In addition, measuring the pH value and potassium level by an arterial blood gas analysis at the ED is recommended for the early evaluation of AH.
意外低体温（AH）的发病率较低，AH 患者的住院时间仍不甚了解。本研究使用日本全国登记数据探讨了哪些因素与 AH 患者的住院时间延长有关。
从 2018 年 12 月 1 日至 2019 年 2 月 28 日，从日本 89 家机构开展的一项针对 AH 的多中心登记研究——Hypothermia STUDY 2018 中获取了≥18 岁、体温≤35°C 的患者的数据。患者被分为“短期住院患者”（7 天内）和“长期住院患者”（超过 7 天）。使用多元缺失后逻辑回归分析，以年龄、虚弱、位置、导致体温过低的原因、体温、pH 值、钾水平和弥散性血管内凝血（DIC）评分为自变量，获得延长住院时间的比值比（OR）。
共纳入 656 例患者，其中 362 例符合分析条件。中位住院时间为 17 天。362 例患者中，265 例（73.2%）住院时间超过 7 天。与住院时间延长相关的因素包括虚弱（OR，2.11；95%置信区间[CI]，1.09-4.10；p = 0.027）、室内（OR，3.20；95% CI，1.58-6.46；p = 0.001）、酒精中毒（OR，0.17；95% CI，0.05-0.56；p = 0.004）、pH 值（OR，0.07；95% CI，0.01-0.76；p = 0.029）、钾水平（OR，1.36；95% CI，1.00-1.85；p = 0.048）和 DIC 评分（OR，1.54；95% CI，1.13-2.10；p = 0.006）。
虚弱、室内情况、酒精中毒、pH 值、钾水平和 DIC 评分是 AH 患者住院时间延长的因素。预防虚弱可能有助于缩短 AH 患者的住院时间。此外，建议在急诊科通过动脉血气分析测量 pH 值和钾水平，以早期评估 AH。
