Accidental hypothermia in a temperate urban emergency department: Comorbidity, pharmacotherapy, and clinical staging patterns

OBJECTIVE: To characterize AVPU-temperature discordance, comorbidities, pharmacotherapy, and ED mortality in patients with accidental hypothermia at a temperate urban academic emergency department. METHODS: Retrospective single-center cohort study (March 2021-March 2025) at a Hungarian academic emergency department. We included 125 patients with ICD-10-coded accidental hypothermia and tympanic temperature below 35 °C. Severity was classified by original Swiss temperature thresholds. The distribution of AVPU consciousness categories across temperature-defined Swiss stages was analyzed. RESULTS: Twenty-three patients (18.4%) died in the ED. Non-survivors had lower temperatures (median 27.1 vs 29.5 °C, p = 0.029). Patients were found indoors as often as outdoors. Consciousness level frequently diverged from temperature-defined severity: 30.0% of Stage III and 18.2% of Stage IV patients were fully alert on presentation. Alcoholism (54.4%), cardiovascular disease (48.0%), and metabolic disorders (30.4%) dominated the comorbidity profile. No single comorbidity or medication class showed a clear unadjusted association with ED mortality. In Firth penalized logistic regression, each 1 °C higher tympanic temperature was associated with lower ED mortality odds (OR 0.83, 95% CI 0.72-0.95, p = 0.005). CONCLUSIONS: Patients with accidental hypothermia were found indoors as often as outdoors. Lower tympanic temperature characterized non-survivors, and this association persisted in exploratory Firth-corrected models. A substantial proportion of patients with moderate-to-severe hypothermia presented with preserved consciousness, suggesting that AVPU may be an imperfect surrogate for temperature-defined hypothermia depth in this cohort. No individual comorbidity or medication class showed a clear unadjusted association with ED mortality in this sample; these exploratory findings should be interpreted cautiously.