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Hypothermia as an Outcome Predictor Tool in Pediatric Trauma: A Propensity Matched Analysis
Thomas R. McCarty, MD, Thomas J. Abramo, MD, Robert T. Maxson, MD, Gregory Albert, MD, Jonathan Orsborn, MD, Mallikarjuna Rettiganti, PhD, Marie Saylors, MPH, Amanda Hollingsworth, MD. University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Background: Trauma is the leading cause of pediatric death in the United States. Hypothermia is an independent risk factor for mortality in adult trauma patients. Single site studies have shown hypothermia in pediatric trauma patients to be associated with increased mortality. To our knowledge, no investigation of hypothermia in pediatric isolated head injury patients has been reported.

Methods: Data was obtained from the National Trauma Database between 2009-2012. Patients were stratified by presence or absence of isolated head injury then subdivided into hypothermic (T<36C) and normothermic groups. We used propensity score matching to 1:1 match hypothermic and normothermic patients and assessed several outcomes including mortality and neurosurgical interventions.

Results: Data from 3,011,482 patients were obtained. 414,562 patients met inclusion criteria. 10,976 patients with and without hypothermia were 1:1 matched. Hypothermic patients had increased mortality, increased neurosurgical interventions, longer hospital stay, and higher transfer rate to other care facilities following hospital discharge.

Conclusions: We have shown hypothermia to be a significant prognostic indicator for pediatric isolated head trauma patients. Further potential application includes: 1) Faster recognition of the severity of the patient's neurological status 2) Objective justification for earlier therapeutic interventions (hypertonic saline, ICP management) 3) Improving patient triage and facilitating transfer to appropriate trauma centers. Further investigation into applying hypothermia as a prognostic indicator in a Pediatric Level One Trauma System is ongoing.


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