Abstract
To identify if triage hypothermia (<36.0 °c) among emergency department (ed) encounters with sepsis are independently associated with mortality. we analyzed data from a multi-stage probability sample survey of visits to united states eds between 2007 and 2015, using two inclusion approaches: an explicit definition based on diagnosis codes for sepsis and a severe sepsis definition, combining evidence of infection with organ dysfunction. we used multivariable regression to determine an association between hypothermia and in-hospital mortality. of 1.2 billion ed encounters (95% confidence interval [ci] 1.0-1.3 billion), 3.1 million (95% ci 2.7-3.5 million) met the explicit sepsis definition; 7.4% (95% ci 75.2-9.7%) had triage hypothermia. the adjusted odds ratio (aor) for hypothermia for in-hospital mortality was 6.82 (95% ci 3.08-15.22). the severe sepsis definition identified 3.5 million (95% 3.1-4.0 million) encounters; 30.3% (95% ci 25.0-34.6%) had triage hypothermia. the aor for hypothermia with mortality was 4.08 (95% ci 2.09-7.95). depending on sepsis definition, 78.1-84.4% had other systemic inflammatory response syndrome vital sign abnormalities. up to one in three patients with sepsis have triage hypothermia, which is independently associated with mortality. 10-20% of patients with hypothermic sepsis do not have other vital sign abnormalities. to identify if triage hypothermia (><36.0 °c) among emergency department (ed) encounters with sepsis are independently associated with mortality. we analyzed data from a multi-stage probability sample survey of visits to united states eds between 2007 and 2015, using two inclusion approaches: an explicit definition based on diagnosis codes for sepsis and a severe sepsis definition, combining evidence of infection with organ dysfunction. we used multivariable regression to determine an association between hypothermia and in-hospital mortality. of 1.2 billion ed encounters (95% confidence interval [ci] 1.0-1.3 billion), 3.1 million (95% ci 2.7-3.5 million) met the explicit sepsis definition; 7.4% (95% ci 75.2-9.7%) had triage hypothermia. the adjusted odds ratio (aor) for hypothermia for in-hospital mortality was 6.82 (95% ci 3.08-15.22). the severe sepsis definition identified 3.5 million (95% 3.1-4.0 million) encounters; 30.3% (95% ci 25.0-34.6%) had triage hypothermia. the aor for hypothermia with mortality was 4.08 (95% ci 2.09-7.95). depending on sepsis definition, 78.1-84.4% had other systemic inflammatory response syndrome vital sign abnormalities. up to one in three patients with sepsis have triage hypothermia, which is independently associated with mortality. 10-20% of patients with hypothermic sepsis do not have other vital sign abnormalities.>
