Pre-Arrival Hypothermia in Pediatric TBI Linked to Higher Mortality

Key Takeaways

• Among 171 children with traumatic brain injury (TBI) admitted to the intensive care unit of a level 1 pediatric trauma center, 40.4% experienced hypothermia before trauma center arrival.
• Mortality was significantly higher among children with prehospital hypothermia than among normothermic children (49.3% vs 15.7%; p < 0.001).
• Temperature was undocumented in 84.6% of EMS, 28.1% of interfacility transport, and 33.3% of outside-hospital encounters.
• The authors concluded that routine prehospital temperature monitoring should be prioritized.

Hypothermia is a component of the trauma “lethal triad” but often goes untreated, and its prevalence among children with TBI before they reach a trauma center has been unknown. Investigators evaluated how often hypothermia occurred along that route, from emergency medical services (EMS) through outside hospitals and interfacility transport.

Investigators retrospectively evaluated a cohort of 171 patients younger than 18 with TBI who were admitted to the intensive care unit at a level 1 pediatric trauma center. They categorized body temperature using EMS, outside-hospital, interfacility, and arrival emergency department measurements: normal (≥36 °C), mild hypothermia (34–36 °C), moderate (32–34 °C), and severe (<32 °C).

Overall, 40.4% of patients experienced prehospital hypothermia. Mortality was 49.3% among hypothermic patients versus 15.7% among normothermic patients (p < 0.001). The reported comparison does not establish whether the association was independent of injury severity. Hypothermia was more frequent in children younger than 2 years (55.1%), in non-accidental trauma (42%), and in transferred patients (66.7%).

Temperature was frequently not recorded: it was undocumented in 84.6% of EMS encounters, 28.1% of interfacility transport encounters, and 33.3% of outside-hospital encounters. Patients without documented temperatures often arrived at the trauma center with temperatures below 34 °C. An undocumented pre-arrival temperature is therefore neither confirmed normothermia nor proof that no measurement was taken.

The retrospective mortality comparison establishes an association, not that hypothermia caused death or that warming or temperature monitoring reduces mortality. The cohort comes from a single level 1 pediatric trauma center and includes only children with TBI who needed intensive care, which limits how widely the findings apply.

The authors concluded that prehospital hypothermia is common, strongly associated with mortality in pediatric TBI, and frequently unassessed, and that routine prehospital temperature monitoring should be prioritized. This cohort did not demonstrate a survival benefit from monitoring.

Clinician Questions

What temperature ranges defined hypothermia severity in children with traumatic brain injury?

The investigators defined normal temperature as 36 °C or higher, mild hypothermia as 34–36 °C, moderate as 32–34 °C, and severe as below 32 °C.

Could children with traumatic brain injury have hypothermia on trauma center arrival without a documented pre-arrival temperature?

Yes. Patients without documented pre-arrival temperatures often arrived at the trauma center with temperatures below 34 °C. Because temperature was undocumented in 84.6% of EMS, 28.1% of interfacility transport, and 33.3% of outside-hospital encounters, a missing entry should not be read as normothermia or as proof that no measurement was taken.