ACCIDENTAL HYPOTHERMIA IN TRAUMA PATIENTS - IS IT RELEVANT TO PREHOSPITAL EMERGENCY TREATMENT

Trauma patients are at great risk of accidental hypothermia (body temp erature [BT] < 36 degrees C). Hypothermia influences the functioning o f all organ systems and can lead to pathological changes, which in tur n additionally complicate the trauma. Furthermore, hypothermia can, e. g., by influencing blood coagulation (reduction of thrombocyte aggrega tion, increased fibrinolysis) have a markedly unfavourable impact upon the in-hospital surgical treatment of the trauma patient. In a prospe ctive study involving 302 trauma patients treated during primary helic opter rescue missions over a 1-year period, we studied the following f actors: (1) incidence and degree of severity of hypothermia; (2) seaso nal influence; (3) possibility of individual risk groups within the st udy group; (4) changes in BT during the prehospital treatment phase; a nd (5) their consequences for emergency treatment. Method. BT was take n upon commencement of emergency treatment and upon release of the pat ient to the receiving hospital. To avoid possible damage to the patien t's tympanic membrane by the thermometer probe, we excluded all patien ts under 16 years of age and those with an indication of an ear or tem poral-bone injury. In all cases standardized patient positioning was a pplied. The statistical evaluation was performed utilizing descriptive presentations and the Mann-Whitney U test and chi-square test. Result s. During study period, a total of 302 trauma patients were treated. O n 228 of these, prehospital temperature monitoring was performed (151 males and 77 females, average age 41.8 years). Because of the establis hed criteria for exceptions and equipment malfunction, no monitoring w as performed on 74 patients. Traffic accidents (69%) were the major ca use of injury (Table 21, predominantly the group with NACA III (32%), followed by NACA IV (22%) and NACA V (18%) (Table 3); 27% had multi-sy stem trauma. BT monitoring disclosed that 49,6% or almost every second trauma patient, had hypothermia. The proportion of hypothermia II deg rees (BT 34 degrees-30 degrees C) versus hypothermia III degrees (BT < 30 degrees C) was 6.6% to 0.5%. Our statistical evaluation did not di sclose any significant connection between season of the year and frequ ency of accidental hypothermia. Special risk factors in regard to freq uency and degree of severity turned out to be ''entrapment'' (98.1% of patients with an entrapment trauma [ET] versus 34.5% without such; P < 0.001) and age (56.8% of patients > 65 years of age without ET and 1 00% with ET; P < 0.001) (Figs. 2, 3). No significant changes in BT wer e noted during the prehospital treatment phase. Clinical symptoms poin ting to hypothermia or other indicators, i.e., shivering, were only no ted in 4.4% of the cases where the patients BT was below normal. Concl usion. Based upon our findings, accidental hypothermia poses a relevan t problem in the prehospital treatment of trauma patients. It is not l imited to a special season of the year. The variability or total absen ce of definite diagnostic symptoms underlines the necessity for prehos pital BT monitoring, whereby tympanic-membrane thermometry has proven to be a worthwhile method.