Factors associated with hypothermia and its response to resuscitation among major trauma patients at St Francis Hospital Nsambya: a prospective observational study.

Abstract

Background: Hypothermia, defined as a core body temperature below 35 °C, is a common yet underappreciated complication among trauma patients. It leads to coagulopathy, impaired immune response, and higher morbidity, with mortality rates rising by 25% after its onset among severely injured trauma patients. This study sought to determine the factors associated with hypothermia and its response to resuscitation among major trauma patients at St. Francis Hospital Nsambya.

Methods: This was a prospective observational study among 99 adult major trauma patients admitted to the emergency department at St. Francis Hospital Nsambya between November 2022 and April 2023. Patients were consecutively enrolled upon arrival and their temperatures were taken using the Braun infrared tympanic thermometer. A pretested data abstraction tool collected information on demographics, injury characteristics, and pre-admission events. The primary outcome was the prevalence of hypothermia. Data analysis was conducted using STATA Version 17.0, employing multivariable logistic regression analysis to determine factors associated with hypothermia.

Results: A total of 99 trauma patients were included in the study, of which 39(39%) were hypothermic on hospital arrival. The majority were males, 78(78.8%) aged 26 to 45 years, 49(49.5%) (range: 27-52). Blunt trauma was the most common mechanism of injury 9(86.9%), followed by penetrating injuries 9(9.1%). Hypothermia was associated with age (Adjusted Odds Ratios [AOR]: 19.94, CI: 1.6-248.65, p = 0.02), body region injured (AOR = 6.28, CI: 1.6-27.75, p = 0.015), ambient temperature (AOR = 0.09, CI: 0.01-0.6, p = 0.012), and warm clothing (AOR = 0.05, CI: 0.01-0.39, p = 0.004). After 30 min of resuscitation, most patients had transitioned from a hypothermic state to a normothermic state, according to initial temperature measurements. This resuscitation involved keeping the patients warm using blankets and external warming devices and administering heated intravenous fluids.

Conclusion: Hypothermia affected 39% of major trauma patients, with advanced age and injured regions as key associations. Routine temperature monitoring, especially for older patients and those with extremity injuries, is essential. Hospitals should implement standardized hypothermia prevention protocols, ensure adequate warming equipment, and train healthcare providers in early detection and management. Further research is needed to optimize warming techniques and resuscitation strategies in trauma care.