Hypothermia and Mortality Among Children in the Emergency Department

OBJECTIVES Hypothermia is a risk factor for poor outcomes in infants and children with sepsis or trauma, but its overall association with mortality among all children in the emergency department (ED) is unknown. We investigated the association between hypothermia and in-hospital mortality among children presenting to the ED. METHODS We performed a retrospective multicenter cohort study of pediatric (<18 years) ED encounters using the 2012–2021 Pediatric Emergency Care Applied Research Network registry. We evaluated the association between first-recorded temperature (as hypothermia [≤36 °C], euthermia, or fever [≥38 °C]) and in-hospital mortality in multivariable logistic regression models adjusted for demographics, vital signs, trauma, and medical complexity. RESULTS Among 5 308 892 encounters (median age 4.92 years, IQR 1.68–10.7; 52.5% male), hypothermia and fever were present in 161 111 (3.0%) and 715 366 (13.5%), respectively. In-hospital mortality occurred in 1918 (0.04%) encounters (39.2% hypothermic, 13.3% febrile). Hypothermia at presentation was associated with in-hospital mortality overall (odds ratio [OR] 20.15, 95% CI 18.00–22.55). This association was present in all subgroup analyses, with greater effects in patients without medical complexity (OR 104.40, 95% CI 84.40–129.14) compared with those with medical complexity (OR 8.81, 95% CI 7.68–10.11), and similar effects among patients with trauma (OR 25.33, 95% CI 15.82–40.53) and without trauma (OR 19.53, 95% CI 17.36–21.98). CONCLUSION Hypothermia is an independent risk factor for mortality among children presenting to the ED, overall and within subgroups. Hypothermia may be an important measure to identify children at highest risk of poor outcomes.