Prevalence of hypothermia prior to trauma center arrival and associated mortality in pediatric traumatic brain injury patients.

OBJECTIVE: Hypothermia is a component of the trauma "lethal triad" but often goes untreated. The prevalence of prehospital hypothermia in pediatric traumatic brain injury (TBI) patients is unknown. We aimed to examine how frequently hypothermia occurred during prehospital care by emergency medical services (EMS), at outside transferring hospitals (OSH), and during interfacility transport (IF) prior to trauma center arrival. METHODS: This was a retrospective cohort study of patients < 18 years old treated for TBI and admitted to the intensive care unit at a level 1 pediatric trauma center. Body temperature was categorized as normal (≥ 36 °C), mild (34-36 °C), moderate (32-34 °C), or severe (< 32 °C) hypothermia using EMS, OSH, IF, and arrival ED measurements. RESULTS: Among 171 patients, 40.4% experienced prehospital hypothermia. Mortality was higher in hypothermic patients (49.3%) compared with normothermic patients (15.7%; p < 0.001). Hypothermia was more frequent in children < 2 years (55.1%), non-accidental trauma (42%), and transfers (66.7%). Temperature was undocumented in 84.6% of EMS, 28.1% of IF, and 33.3% of OSH encounters. Patients without documented temperatures often arrived at the trauma center with temperatures below 34 °C. CONCLUSIONS: Prehospital hypothermia is common and strongly associated with mortality in pediatric TBI, yet frequently unassessed. Routine prehospital temperature monitoring should be prioritized.