2002 Hypothermia on admission in patients with severe brain injury.pdf

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2002 Hypothermia on admission in patients with severe brain injury.pdf

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2002 Hypothermia on admission in patients with severe brain injury

JOURNAL OF NEUROTRAUMA Volume 19, Number 3, 2002 ? Mary Ann Liebert, Inc. Hypothermia on Admission in Patients with Severe Brain Injury GUY L. CLIFTON,1 EMMY R. MILLER,1 SUNG C. CHOI,2 HARVEY S. LEVIN,3 STEPHEN MCCAULEY,3 KENNETH R. SMITH, JR.,4 J. PAUL MUIZELAAR,5 DONALD W. MARION,6 and THOMAS G. LUERSSEN7 ABSTRACT Data from the “National Acute Brain Injury Study: Hypothermia” were examined to identify the impact of hypothermia on admission. In all patients, temperature was measured at randomization using bladder catheters with thermistors. Patients assigned to hypothermia were cooled using fluid- circulating pads. Outcome was assessed at 6 months using the dichotomized Glasgow Outcome Scale (good outcome5 good recovery/moderate disability; poor outcome5 severe disability/vegetative/ dead). One-hundred and two patients (hypothermia, 62; normothermia, 40) were hypothermic on admission (#35.0°C). Hypothermia-on-admission patients assigned to normothermia (n 5 40) had a 78% poor outcome, and normothermia-on-admission patients assigned to normothermia had a 52% poor outcome (p , 0.004). Hypothermia-on-admission patients assigned to hypothermia had a lower percentage of poor outcomes than those assigned to normothermia (hypothermia, 61%; nor- mothermia, 78%; p 5 0.09). Patients over 45 years of age had an adverse effect of hypothermia re- gardless of admission temperature due to medical complications. Patients who were hypothermic on admission, age# 45 years (n 5 81), and assigned to hypothermia had a significantly lower per- centage of poor outcomes than those assigned to normothermia (hypothermia, 52%; normothermia, 76%; p 5 0.02). Factors associated with hypothermia on admission were increased age, prehospital hypotension, smaller size, positive blood alcohol, larger volume of pre-hospital fluids, slightly higher injury severity, and winter enrollment The treatment effect was found in all of the four centers, which randomized the majority (80%) of the patients. It i