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The forgotten vital sign: temperature patterns and associations in 642 trauma patients at an urban level I trauma center.

OBJECTIVES
(1) Identify compliance with the standard of practice that trauma patients have body temperature measurement recorded. (2) Describe the range of temperatures in a sample of trauma patients. (3) Identify associations between temperature and other clinical and trauma variables.


DESIGN
Descriptive analysis of a cohort of trauma victims.


METHODS
We identified patients with traumatic injuries during a 14-month period with a computer-based trauma registry. Patient charts were reviewed for demographic information, injury data, assessment data, and outcomes. The ED chart, nursing notes, and trauma flow sheets were reviewed in search of a documented temperature assessment.


RESULTS
A cohort of 642 trauma patients was identified during the study period. Thirty-two percent were admitted to an ICU; 17% went directly to surgery. The mortality rate was 3.4% (n = 22). Most patients were male (65%), young (mean age, 34 +/- 18 years), and victims of blunt trauma (93%). Seventy-seven percent of patients had a temperature measurement recorded in the emergency department. Patients with minor injuries were more likely to have had their temperature measured (79%) than those with moderate (64%) or severe (64%) injuries (p = 0.0009). Among the 495 patients with recorded temperatures, temperatures ranged from 26.5 degrees to 39 degrees C, with a mean of 36.7 degrees +/- 1.1 degrees C. Ten percent of the patients had temperatures less than 36 degrees C. Temperature correlated negatively with ISS (r = -0.20; p = 0.0001) and positively with RTS (r = 0.37; p < 0.0001).


CONCLUSIONS
We conclude that a significant proportion of trauma patients brought to a level I trauma center are hypothermic, with temperatures lower in patients more severely injured and in patients who die. Yet temperature measurement, a simple and standard nursing procedure, is often ignored in trauma resuscitation.