Accidental hypothermia in Poland – estimation of prevalence, diagnostic methods and treatment

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Rafał Drwiła²  Robert Gałązkowski¹  Tomasz Darocha²  Sylweriusz Kosiński³ 

[1] Department of Emergency Medical Services, Medical University of Warsaw, Polish Medical Air Rescue, Warsaw, Poland;Department of Cardiac Surgery, John Paul II Hospital, Collegium Medicum, Jagiellonian University, Cracow, Poland;Tatra Mountain Rescue Service, Zakopane, Poland

关键词: Body temperature;    Thermometers;    Rewarming;    Prevalence;    Accidental hypothermia;   

Others  :  1132257
DOI  :  10.1186/s13049-014-0086-7

 received in 2014-11-17, accepted in 2014-12-30,  发布年份 2015

【 摘 要 】

Background

The incidence of hypothermia is difficult to evaluate, and the data concerning the morbidity and mortality rates do not seem to fully represent the problem. The aim of the study was to estimate the actual prevalence of accidental hypothermia in Poland, as well as the methods of diagnosis and management procedures used in emergency rooms (ERs).

Methods

A specially designed questionnaire, consisting of 14 questions, was mailed to all the 223 emergency rooms (ER) in Poland. The questions concerned the incidence, methods of diagnosis and risk factors, as well as the rewarming methods used and available measurement instruments.

Results

The analysis involved data from 42 ERs providing emergency healthcare for the population of 5 305 000. The prevalence of accidental hypothermia may have been 5.05 cases per 100.000 residents per year. Among the 268 cases listed 25% were diagnosed with codes T68, T69 or X31, and in 75% hypothermia was neither included nor assigned a code in the final diagnosis. The most frequent cause of hypothermia was exposure to cold air alongside ethanol abuse (68%). Peripheral temperature was measured in 57%, core temperature measurement was taken in 29% of the patients. Peripheral temperature was measured most often at the axilla, while core temperature measurement was predominantly taken rectally. Mild hypothermia was diagnosed in 75.5% of the patients, moderate (32-28°C) in 16.5%, while severe hypothermia (less than 28°C) in 8% of the cases. Cardiopulmonary resuscitation was carried out in 7.5% of the patients. The treatment involved mainly warmed intravenous fluids (83.5%) and active external rewarming measures (70%). In no case was extracorporeal rewarming put to use.

Conclusions

The actual incidence of accidental hypothermia in Polish emergency departments may exceed up to four times the official data. Core temperature is taken only in one third of the patients, the treatment of hypothermic patients is rarely conducted in intensive care wards and extracorporeal rewarming techniques are not used. It may be expected that personnel education and the development of management procedures will brighten the prognosis and increase the survival rate in accidental hypothermia.

【 授权许可】

   
2015 Kosiński et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Baumgartner EA, Belson M, Rubin C, Patel M: Hypothermia and other cold-related morbidity emergency department visits: United States, 1995–2004. Wilderness Environ Med 2008, 19:233-7.
• [2]Bierens JJ, Uitslager R, Swenne-Van Ingen MM, Van Stiphout WA: Accidental hypothermia: incidence, risk factors and clinical course of patients admitted to hospital. Eur J Emerg Med 1995, 2:38-46.
• [3]Herity B, Daly L, Bourke GJ, Horgan JM: Hypothermia and mortality and morbidity. an epidemiological analysis. J Epidemiol Community Health 1991, 45:19-23.
• [4]Vassal T, Benoit-Gonin B, Carrat F, Guidet B: Severe accidental hypothermia treated in an ICU. Chest 2001, 120:1998-2003.
• [5]Brändström H, Johansson G, Giesbrecht GG, Ängquist KA, Haney MF: Accidental cold-related injury leading to hospitalization in northern Sweden: an eight-year retrospective analysis. Scand J Trauma Resusc Emerg Med 2014, 22:6. BioMed Central Full Text
• [6]Taylor NA, Griffiths RF, Cotter JD: Epidemiology of hypothermia: fatalities and hospitalisations in New Zealand. NZ J Med 1994, 24:705-10.
• [7]Hislop LJ, Wyatt JP, McNueghton GW, Ireland IJ: Urban hypothermia in the West of Scotland. BMJ 1995, 311:725-7.
• [8]Danzl DF, Pozos RS, Auerbach PS, Glazer S: Multicenter hypothermia survey. Ann Emerg Med 1987, 16:1042-55.
• [9]Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJLM, et al.: European resuscitation council guidelines for resuscitation 2010 section 8. cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2010, 81:1400-33.
• [10]Durrer B, Brugger H, Syme D: The medical on-site treatment of hypothermia ICAR-MEDCOM recommendation. High Alt Med Biol 2003, 4:99-110.
• [11]Strapazzon G, Procter E, Paal P, Brugger H: Pre-hospital core temperature measurement in accidental and therapeutic hypothermia. High Alt Med Biol 2014, 15:104-11.
• [12]Walpoth BH, Galdikas J, Leupi F, Muehlemann W, Schlaepfer P, Althaus U: Assessment of hypothermia with a new “tympanic” thermometer. J Clin Monit 1994, 10:91-6.
• [13]Brown DJ, Brugger H, Boyd J: Accidental hypothermia. N Engl J Med 2012, 367:1930-8.
• [14]Megarbane B, Axler O, Chary I, Pompier R: Hypothermia with indoor occurrence is associated with a worse outcome. Intensive Care Med 2000, 26:1843-9.
• [15]Ledingham IM, Mone JG: Treatment of accidental hypothermia: a prospective clinical study. BMJ. 1980, 280:1102-1105.
• [16]Roeggla M, Holzer M, Roeggla G, Frosard M: Prognosis of accidental hypothermia in the urban setting. J Intensive Care Med 2001, 16:142-9.
• [17]van der Ploeg GJ, Goslings JC, Walpoth BH, Bierens JJ: Accidental hypothermia: rewarming treatments, complications and outcomes from one university medical centre. Resuscitation 2010, 81:1550-5.
• [18]Ruttmann E, Weissenbacher A, Ulmer H, Müller L: Prolonged extracorporeal membrane oxygenation-assisted support provides improved survival in hypothermic patients with cardiocirculatory arrest. J Thorac Cardiovasc Surg 2007, 134:594-600.
• [19]Paal P, Brown D: Cardiac arrest from accidental hypothermia, a rare condition with potentially excellent neurological outcome, if you treat it right. Resuscitation 2014, 85(6):707-8.
• [20]Schober A, Sterz F, Handler C, Kürkciyan I, Laggner A, Röggla M, et al.: Cardiac arrest due to accidental hypothermia-a 20 year review of a rare condition in an urban area. Resuscitation 2014, 85:749-56.
• [21]Holmström P, Boyd J, Sorsa M, Kuisma M: A case of hypothermic cardiac arrest treated with an external chest compression device (LUCAS) during transport to re-warming. Resuscitation 2005, 67:139-41.
• [22]Darocha T, Kosiński S, Jarosz A, Gałązkowski R, Sadowski J, Drwiła R. Severe accidental hypothermia center. Eur J Emerg Med. 2014. doi:10.1097/MEJ.0000000000000213
• [23]International Hypothermia Registry. https://www.hypothermia-registry.org.