Body temperature and in-hospital mortality in trauma patients: analysis of a nationwide trauma database in Japan



Avoiding body temperature (BT) abnormalities has been emphasized in trauma care, and BT correction in the initial treatment period may improve patient outcome. However, the effect of hyperthermia at hospital arrival on mortality in trauma patients is unclear. This study aimed to identify the association between BT and in-hospital mortality among adult trauma patients.


This was a retrospective analysis of a multi-centre prospective cohort study. Data were obtained from the Japan Trauma Data Bank (JTDB). Adult trauma patients who were transferred directly from the scene of injury to the hospital and registered in the JTDB between January 2004 and December 2017 were included. The primary outcome was the association between BT at hospital arrival and in-hospital mortality. BT at hospital arrival was classified by 1 °C strata. We conducted multivariable logistic regression analyses to calculate the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for in-hospital mortality for each BT group using 36.0–36.9 °C as a reference.


Overall, 153,117 patients were included. The total mortality rate was 7% (n = 10,118). The adjusted OR for in-hospital mortality for < 35.0 °C was 1.65 (95% CI 1.51–1.79, p < 0.001), 35.0–35.9 °C was 1.33 (95% CI 1.25–1.41, p < 0.001), 37.0–37.9 °C was 0.99 (95% CI 0.91–1.07, p = 0.639), 38.0–38.9 °C was 1.30 (95% CI 1.08–1.56, p = 0.007) and > 39.0 °C was 1.62 (95% CI 1.18–2.22, p = 0.003) compared to that for normothermia.


Our results reveal that hypothermia and hyperthermia at hospital arrival are associated with increased in-hospital mortality in adult trauma patients.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information




AO and YO contributed to the conception and design of this study, and AO wrote the manuscript. RI, HN, and WI contributed to data acquisition and submitted the application to obtain the data from the JTDB. YO and TK assisted with the statistical analysis because of their background in epidemiology and statistics. All authors revised the daft critically, approved the contents of the manuscript, and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Yohei Okada.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. The ethics committee of the Japanese Association for the Surgery of Trauma approved the JTDB. The approval documents of the Japanese Association for the Surgery of Trauma and the representative institution (National Defense Medical College Research Institute) are available on the JTDB website ( (Approval ID no 2548). Approval was granted by the Ethics Committee of Kyoto Daini Red Cross Hospital (Sp 2019-10).

Consent to participate

The ethics committee of each institution affirmed that informed consent was waived for registration in the JTDB and for retrospective analysis because of the anonymous nature of the data.

Consent for publication

The ethics committee of each institution affirmed that informed consent was waived for registration in the JTDB and for retrospective analysis because of the anonymous nature of the data.

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Okada, A., Okada, Y., Narumiya, H. et al. Body temperature and in-hospital mortality in trauma patients: analysis of a nationwide trauma database in Japan. Eur J Trauma Emerg Surg (2020).

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  • Trauma
  • Hyperthermia
  • Hypothermia
  • Fever
  • Seasons