Prognostic impact of body temperature trajectories from emergency department arrival to intensive care unit admission – insights from the TraumaRegister DGU^®

Hypothermia is a significant and independent predictor of mortality in patients with severe trauma and constitutes a key component of the trauma-related lethal triad, along with acidosis and coagulopathy. While the prognostic impact of hypothermia at isolated time points is well established, the clinical relevance of dynamic body temperature changes during the early in-hospital phase remains poorly understood. This study aims to evaluate the association between body temperature trajectories from emergency department (ED) admission to intensive care unit (ICU) transfer and clinical outcomes in major trauma patients.

Retrospective data from the TraumaRegister DGU^® (TR-DGU) for the period 2015–2023 were analysed. Inclusion criteria comprised an Injury Severity Score (ISS) ≥ 9, ICU admission following ED care, and documented core body temperatures at both ED and ICU. Hypothermia was defined as a body temperature ≤ 35 °C. Patients were stratified into four groups based on the presence or absence of hypothermia at each time point. Further subgroup analysis assessed temperature trends (decreasing vs. stable/increasing) and their associations with mortality, coagulopathy, transfusion requirements, and sex distribution.

A total of 34,877 patients met the inclusion criteria (mean age 54.2 ± 20.9 years; 71.6% male; mean ISS 22.8 ± 11.5). Hypothermia was present in 10.7% upon ED admission and 9.7% of patients at ICU transfer. Persistent hypothermia was associated with the highest mortality (43.5%), coagulopathy (28.2%), and transfusion rates (31.8%). New onset of hypothermia in the ICU was also linked to poor prognosis (mortality 31.9%). Patients with a temperature decrease (11.2%) had significantly higher injury severity and mortality compared to those with stable or rising temperatures. Female patients were disproportionately represented in hypothermic ICU groups (38%).

Hypothermia—particularly when persistent or newly acquired—emerges as a strong predictor of adverse outcomes in trauma patients. Dynamic temperature monitoring between ED and ICU provides critical prognostic insights that extend beyond static measurements. Early identification and management of thermal dysregulation, including sex-specific considerations, should be integral components of contemporary trauma care protocols.