Association of triage hypothermia with in-hospital mortality among patients in the emergency department with suspected sepsis

J Crit Care. 2020 Dec:60:27-31. doi: 10.1016/j.jcrc.2020.07.011. Epub 2020 Jul 16.

Abstract

Purpose: To identify if triage hypothermia (<36.0 °C) among emergency department (ED) encounters with sepsis are independently associated with mortality.

Methods: We analyzed data from a multi-stage probability sample survey of visits to United States EDs between 2007 and 2015, using two inclusion approaches: an explicit definition based on diagnosis codes for sepsis and a severe sepsis definition, combining evidence of infection with organ dysfunction. We used multivariable regression to determine an association between hypothermia and in-hospital mortality.

Results: Of 1.2 billion ED encounters (95% confidence interval [CI] 1.0-1.3 billion), 3.1 million (95% CI 2.7-3.5 million) met the explicit sepsis definition; 7.4% (95% CI 75.2-9.7%) had triage hypothermia. The adjusted odds ratio (aOR) for hypothermia for in-hospital mortality was 6.82 (95% CI 3.08-15.22). The severe sepsis definition identified 3.5 million (95% 3.1-4.0 million) encounters; 30.3% (95% CI 25.0-34.6%) had triage hypothermia. The aOR for hypothermia with mortality was 4.08 (95% CI 2.09-7.95). Depending on sepsis definition, 78.1-84.4% had other systemic inflammatory response syndrome vital sign abnormalities.

Conclusion: Up to one in three patients with sepsis have triage hypothermia, which is independently associated with mortality. 10-20% of patients with hypothermic sepsis do not have other vital sign abnormalities.

Keywords: Emergency department; Hypothermia; Mortality; Sepsis; Septic shock; Severe sepsis.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Comorbidity
  • Cross-Sectional Studies
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Hospital Mortality*
  • Humans
  • Hypothermia / diagnosis
  • Hypothermia / epidemiology*
  • Hypothermia / mortality*
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Odds Ratio
  • Sepsis / epidemiology*
  • Sepsis / mortality*
  • Triage / methods*
  • United States / epidemiology
  • Young Adult