Risk factors for hypothermia on trauma center arrival in injured children

BACKGROUND: Pediatric trauma patients presenting with abnormal body temperature, especially hypothermia, are at higher risk for poor outcomes. However, risk factors for hypothermia in injured children remain unclear, and temperature data may be inconsistently documented. This study aimed to identify predictors of hypothermia and missing temperature documentation among pediatric trauma patients. METHODS: We conducted a retrospective cohort study of trauma patients <18 years of age using the 2021-2023 Trauma Quality Improvement Program dataset. Patients were categorized by arrival temperature: normothermia (36-38°C), mild hypothermia (35-36°C), moderate/severe hypothermia (<35°C), hyperthermia (>38°C), or missing/invalid. Chi-square and Wilcoxon rank-sum tests assessed group differences. Multivariable logistic regression identified independent predictors of any hypothermia (≤36°C), moderate/severe hypothermia (<35°C), and missing temperature. RESULTS: Among 516,717 patients, 15,665 (3.0%) had mild hypothermia, 2,584 (0.5%) had moderate/severe hypothermia, and 42,333 (8.2%) had a missing/invalid arrival temperature. Median age was 10 years; 65.1% were male. Hypothermia was associated with younger age, certain racial/ethnic groups, field arrival, child abuse and penetrating injuries, air emergency medical services (EMS) transport, injury severity, and traumatic brain injury (TBI). Independent predictors of any hypothermia included air EMS transport (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.67-1.82), firearm injury (OR 1.97, 95% CI: 1.85-2.10), and TBI severity (OR 1.43 for mild, 2.06 for moderate, 2.40 for severe). Risk factors for moderate/severe hypothermia were similar but of greater magnitude. Missing/invalid temperature documentation was more likely with severe injuries and among Black/African-American (OR 1.14, 95% CI: 1.11-1.17) and Hispanic patients (OR 1.05, 95% CI: 1.02-1.08). CONCLUSION: This study identifies key predictors of hypothermia and missing temperature documentation in pediatric trauma patients. Findings highlight areas for further study and potential opportunities for quality improvement, particularly in temperature management during air EMS transport and in ensuring consistent assessment upon hospital arrival. Potential disparities in temperature measurement warrant further investigation. LEVEL OF EVIDENCE: Prognostic/Epidemiological; Level III.