Internal and Emergency Medicine

, Volume 12, Issue 8, pp 1225–1233 | Cite as

Accidental hypothermia: factors related to long-term hospitalization. A retrospective study from northern Finland

EM - ORIGINAL
First Online:
Received:
Accepted:

Abstract

Accidental hypothermia has a low incidence, but is associated with a high mortality rate. Knowledge about concomitant factors, complications, and length of hospital stay is limited. A retrospective cohort study on patients with accidental hypothermia admitted to Oulu University Hospital in Finland, over a 5-year period. Patients were categorized as short-stay patients (7 days or less) and long-stay patients (more than 7 days) according to their length of stay in hospital. From a total of 105 patients, 67 patients were included in the analyses. Alcohol abuse was the most common concomitant factor (54 %). Median length of hospital stay was 4 days, and 16 patients (24 %) stayed in hospital over 7 days (median 15 days). Thirty-day mortality was low (14/105, 13 %). Patients with long-term hospitalization had a lower initial temperature (28.4 versus 31.2 °C, p = 0.011), a lower level of consciousness (GCS score 8.4 versus 12.8, p = 0.003), more severe acidosis (pH 7.08 versus 7.28, p = 0.005, and lactate 7.2 versus 3.9, p = 0.043), and a lower level of platelets (183 versus 242, p = 0.041) on admission compared with short-stay patients. Thirty-six patients (54 %) had at least one complication, and this prolonged median hospital treatment for 2.5 days (p < 0.001). Alcohol is the most common concomitant factor and every fourth patient spends more than 7 days in hospital. Long-term hospitalization is related to a lower core temperature, lower consciousness, more severe lactic acidosis, lower platelet level and infections, rhabdomyolysis, and renal failure.

Keywords

Accidental hypothermia Concomitant factors Emergency medicine Complications Long-term hospitalization 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

The authors would like to thank biostatistician Pasi Ohtonen and research nurses Sinikka Sälkiö and Tarja Lamberg for their valuable contribution with the extraction of data. The authors would like to thank MD Sami Länkimäki for his comments on data collection.

Compliance with ethical standards

Conflict of interest

The authors state that they have no conflicts of interest.

Statement of human and animal rights

The study was approved by the Department of Operative Care of the Oulu University Hospital. Due to the retrospective design, an exemption from consent was obtained from the local ethics committee; the data had already been collected for clinical purposes, and none of the patients were contacted for the purposes of this study.

Informed consent

For this type of study formal consent is not required. The data had already been collected for clinical purposes, and none of the patients were contacted for the purposes of this study.

References

  1. 1.
    Larach MG (1995) Accidental hypothermia. Lancet 345:493–498CrossRefPubMedGoogle Scholar
  2. 2.
    Brown DJA, Brugger H, Boyd J, Paal P (2012) Accidental hypothermia. N Engl J Med 367:1930–1938CrossRefPubMedGoogle Scholar
  3. 3.
    Corneli HM (2012) Accidental hypothermia. Pediatr Emerg Care 28:475–480CrossRefPubMedGoogle Scholar
  4. 4.
    Truhlár A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJ, Brattebø G, Brugger H, Dunning J, Hunyadi-Anticevic S, Koster RW, Lockey DJ, Lott C, Paal P, Perkins GD, Sandroni C, Thies K-, Zideman DA, Nolan JP, Barelli A, Böttiger BW, Georgiou M, Handley AJ, Lindner T, Midwinter MJ, Monsieurs KG, Wetsch WA, European Resuscitation Council Guidelines for Resuscitation 2015. Section 4 (2015) Cardiac arrest in special circumstances. Resuscitation 2015(95):148–201CrossRefGoogle Scholar
  5. 5.
    Ploeg GJ, Goslings JC, Walpoth BH, Bierens JJ (2010) Accidental hypothermia: rewarming treatments, complications and outcomes from one university medical centre. Resuscitation 81:1550–1555CrossRefPubMedGoogle Scholar
  6. 6.
    Silfvast T, Pettilä V (2003) Outcome from severe accidental hypothermia in Southern Finland—a 10-year review. Resuscitation 59:285–290CrossRefPubMedGoogle Scholar
  7. 7.
    Hilmo J, Naesheim T, Gilbert M (2014) “Nobody is dead until warm and dead”: prolonged resuscitation is warranted in arrested hypothermic victims also in remote areas—a retrospective study from northern Norway. Resuscitation 85:1204–1211CrossRefPubMedGoogle Scholar
  8. 8.
    Mégarbane B, Axler O, Chary I, Pompier R, Brivet FG (2000) Hypothermia with indoor occurrence is associated with a worse outcome. Intensive Care Med 26:1843–1849CrossRefPubMedGoogle Scholar
  9. 9.
    Debaty G, Moustapha I, Bouzat P, Maignan M, Blancher M, Rallo A, Brun J, Chavanon O, Danel V, Carpentier F, Payen J, Briot R (2015) Outcome after severe accidental hypothermia in the French Alps: a 10-year review. Resuscitation 93:118–123CrossRefPubMedGoogle Scholar
  10. 10.
    Central Statistical Office of Finland. Causes of death in Finland. ISSN = 1799-5051. Helsinki. http://www.tilastokeskus.fi.pc124152.oulu.fi:8080/til/ksyyt/ksyyt_2006-10-26_uut_001.html. Accessed 22 April 2015
  11. 11.
    Wanscher M, Agersnap L, Ravn J, Yndgaard S, Nielsen JF, Danielsen ER, Hassager C, Romner B, Thomsen C, Barnung S, Lorentzen AG, Høgenhaven H, Davis M, Møller JE (2012) Outcome of accidental hypothermia with or without circulatory arrest. Experience from the Danish Præstø Fjord boating accident. Resuscitation 83:1078–1084CrossRefPubMedGoogle Scholar
  12. 12.
    Oulu University Hospital (2015) http://www.ppshp.fi/tietoatoiminnasta. Accessed 24 April 2015
  13. 13.
    Castrén M, Kurola J, Lund V, Silfvast T (2016) Ensihoito-opas. Jyväskylä, Kustannus Oy DuodecimGoogle Scholar
  14. 14.
    The Finnish Medical Society Duodecim (2016) Current care guidelines of Finland. The National Guideline for Resuscitation. Published 03.02.2016. http://www.kaypahoito.fi/web/kh/suositukset/suositus?id=hoi17010. Accessed 03 March 2016
  15. 15.
    Brändström H, Johansson G, Giesbrecht GG, Ängquist K-A, Haney MF (2014) Accidental cold-related injury leading to hospitalization in northern Sweden: an eight-year retrospective analysis. Scand J Trauma Resusc Emerg Med 22:6CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Lapostolle F, Sebbah JL, Couvreur J, Koch FX, Savary D, Tazarourte K, Egman G, Mzabi L, Galinski M, Adnet F (2012) Risk factors for onset of hypothermia in trauma victims: the HypoTraum study. Crit Care 16:R142CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kosinski S, Darocha T, Galazkowski R, Drwila R (2015) Accidental hypothermia in Poland—estimation of prevalence, diagnostic methods and treatment. Scand J Trauma Resusc Emerg Med 23:13CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Schober A, Sterz F, Handler C, Kürkciyan I, Laggner A, Röggla M, Schwameis M, Wallmueller C, Testori C (2014) Cardiac arrest due to accidental hypothermia—a 20 year review of a rare condition in an urban area. Resuscitation 85:749–756CrossRefPubMedGoogle Scholar
  19. 19.
    Sawamoto K, Bird SB, Katayama Y, Maekawa K, Uemura S, Tanno K, Narimatsu E (2014) Outcome from severe accidental hypothermia with cardiac arrest resuscitated with extracorporeal cardiopulmonary resuscitation. Am J Emerg Med 32:320–324CrossRefPubMedGoogle Scholar
  20. 20.
    Sawamoto K, Tanno K, Takeyama Y, Asai Y (2012) Successful treatment of severe accidental hypothermia with cardiac arrest for a long time using cardiopulmonary bypass-report of a case. Int J Emerg Med 5:9CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Yoon HJ, Kim MC, Park JW, Yang MA, Lee CB, Sun IO, Lee KY (2014) Hypothermia-induced acute kidney injury in an elderly patient. Korean J Intern Med 29:111–115CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Freude T, Gillen S, Ehnert S, Nüssler A, Stöckle U, Charalambakis N, Döbele S, Pscherer S (2014) Therapeutic peritoneal lavage with warm saline solution as an option for a critical hypothermic trauma patient. Wien Klin Wochenschr 126:56–61CrossRefPubMedGoogle Scholar
  23. 23.
    Mair P, Frimmel C, Vergeiner G, Hohlrieder M, Moroder L, Hoesl P, Voelckel W (2013) Emergency medical helicopter operations for avalanche accidents. Resuscitation 84:492–495CrossRefPubMedGoogle Scholar

Copyright information

© SIMI 2016

Authors and Affiliations

  1. 1.Division of Intensive Care Medicine, and Medical Research Center Oulu, Department of Anaesthesiology, Oulu University Hospital and Research Group of Surgery, Anaesthesiology and Intensive Care, Medical FacultyUniversity of OuluOuluFinland

Personalised recommendations