The collected data were re-checked by the J-Point Registry Working Group members and either confirmed or checked with the appropriate institution if there were concerns regarding the data’s validity. Clinical data were extracted by emergency physicians using a predefined data extraction sheet. Patients were excluded from the registry if they or their family members explicitly refused to be included in the registry. These patients were treated for hypothermia between April 1, 2011, and March 31, 2016, and had a body temperature of unknown or ≤ 35.0 ☌.
The J-point registry includes patients who are retrospectively identified at each center using the International Classification of Diseases, Tenth Revision (ICD-10) code for hypothermia (T68). The non-CCMC centers are public or private general hospitals that cover a smaller regional community, and, generally, advanced treatment such as ECMO is unavailable. In Japan, CCMCs are certified by the Ministry of Health, Labour and Welfare based on EDs that treat patients for shock, trauma, resuscitation, and critical care which serve approximately 500,000 residents in each region in these CCMCs, advanced treatment like extracorporeal membrane oxygenation (ECMO) is generally available. Each year, the centers had a median of 19,651 ED visits (interquartile range 13,281–27,554 visits). Eight centers are designated as Critical Care Medical Centers (CCMCs), and four sites are the emergency departments (EDs) of non-CCMC general hospitals in urban areas of the Kyoto, Osaka, and Shiga prefectures in Japan. We obtained epidemiological and clinical information from the J-point registry database which collects data from a network of Japanese centers that treat patients with AH. The present study aimed to develop and validate a severity scaling system for predicting in-hospital mortality using data from Japanese patients who experienced AH in urban settings.
Thus, a simple and user-friendly severity scale is needed to estimate mortality after AH in urban settings.
Unfortunately, it is difficult to understand how these factors might influence mortality, especially in an emergency setting. Moreover, mortality is known to be associated with various other factors, such as age, activities of daily living (ADL), hemodynamic instability, hyperkalemia, and acidemia. However, other research has indicated that core body temperature is not associated with in-hospital mortality in urban settings. The severity of AH is traditionally evaluated using the Swiss grading system which is based on core body temperature and simple clinical findings. This might lead to inappropriate decision-making due to a lack of accurate information for the prognosis. Therefore, patients with AH must be immediately assessed to determine their severity and select appropriate advanced resuscitation and critical care techniques.Īlthough AH patients require immediate assessment of the severity and critical care, there is no established risk assessment tool specialized for AH patients. This condition is associated with high risks of hemodynamic collapse and mortality (24–40%), as the cooling heart results in decreased cardiac output and electrical conduction abnormalities leading to life-threatening dysrhythmias, such as bradycardic atrial fibrillation or ventricular fibrillation. Accidental hypothermia (AH) involves an unintentional decrease in core body temperature to ≤ 35 ☌.