Hypothermia on admission in patients with severe brain injury

Guy L. Clifton, Emmy R. Miller, Sung C. Choi, Harvey S. Levin, Stephen McCauley, Kenneth R. Smith, Jan Paul Muizelaar, Donald W. Marion, Thomas G. Luerssen

Research output: Contribution to journalArticle

112 Citations (Scopus)

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 outcome = good recovery/moderate disability; poor outcome = 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 = 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%; normothermia, 78%; p = 0.09). Patients over 45 years of age had an adverse effect of hypothermia regardless of admission temperature due to medical complications. Patients who were hypothermic on admission, age ≤ 45 years (n = 81), and assigned to hypothermia had a significantly lower percentage of poor outcomes than those assigned to normothermia (hypothermia, 52%; normothermia, 76%; p = 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 is unclear whether the improved outcome when hypothermia is maintained is a beneficial effect of very early hypothermia induction or an adverse effect of permitting the patients to rewarm passively.

Original languageEnglish (US)
Pages (from-to)293-301
Number of pages9
JournalJournal of Neurotrauma
Volume19
Issue number3
StatePublished - 2002

Fingerprint

Patient Admission
Hypothermia
Brain Injuries
Glasgow Outcome Scale
Temperature
Random Allocation
Hypotension
Urinary Bladder

Keywords

  • Hypothermia on admission
  • Maintenance of hypothermia
  • Outcome
  • Severe brain injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Clifton, G. L., Miller, E. R., Choi, S. C., Levin, H. S., McCauley, S., Smith, K. R., ... Luerssen, T. G. (2002). Hypothermia on admission in patients with severe brain injury. Journal of Neurotrauma, 19(3), 293-301.

Hypothermia on admission in patients with severe brain injury. / Clifton, Guy L.; Miller, Emmy R.; Choi, Sung C.; Levin, Harvey S.; McCauley, Stephen; Smith, Kenneth R.; Muizelaar, Jan Paul; Marion, Donald W.; Luerssen, Thomas G.

In: Journal of Neurotrauma, Vol. 19, No. 3, 2002, p. 293-301.

Research output: Contribution to journalArticle

Clifton, GL, Miller, ER, Choi, SC, Levin, HS, McCauley, S, Smith, KR, Muizelaar, JP, Marion, DW & Luerssen, TG 2002, 'Hypothermia on admission in patients with severe brain injury', Journal of Neurotrauma, vol. 19, no. 3, pp. 293-301.
Clifton GL, Miller ER, Choi SC, Levin HS, McCauley S, Smith KR et al. Hypothermia on admission in patients with severe brain injury. Journal of Neurotrauma. 2002;19(3):293-301.
Clifton, Guy L. ; Miller, Emmy R. ; Choi, Sung C. ; Levin, Harvey S. ; McCauley, Stephen ; Smith, Kenneth R. ; Muizelaar, Jan Paul ; Marion, Donald W. ; Luerssen, Thomas G. / Hypothermia on admission in patients with severe brain injury. In: Journal of Neurotrauma. 2002 ; Vol. 19, No. 3. pp. 293-301.
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