{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T23:36:17Z","timestamp":1791848177321,"version":"4.3.4"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"Supplement_3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,19]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The association between hypothermia, coagulopathy, and acidosis in trauma is well described. Hypothermia mitigation starts in the prehospital setting; however, it is often a secondary focus after other life-saving interventions. The deployed environment further compounds the problem due to prolonged evacuation times in rotary wing aircraft, resource limitations, and competing priorities. This analysis evaluates hypothermia in combat casualties and the relationship to resuscitation strategy with blood products.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using the data from the Department of Defense Joint Trauma Registry from 2003 to 2021, a retrospective analysis was conducted on adult trauma patients. Inclusion criteria was arrival at the first military treatment facility (MTF) hypothermic (&amp;lt;95\u00baF). Study variables included: mortality, year, demographics, battle vs non-battle injury, mechanism, theater of operation, vitals, and labs. Subgroup analysis was performed on severely injured (15\u2009&amp;lt;\u2009ISS\u2009&amp;lt;\u200975) hypothermic trauma patients resuscitated with whole blood (WB) vs only component therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 69,364 patients included, 908 (1.3%) arrived hypothermic; the vast majority of whom (N\u2009=\u2009847, 93.3%) arrived mildly hypothermic (90\u201394.9\u00b0F). Overall mortality rate was 14.8%. Rates of hypothermia varied by year from 0.7% in 2003 to 3.9% in 2014 (P &amp;lt;0.005). On subgroup analysis, mortality rates were similar between patients resuscitated with WB vs only component therapy; though base deficit values were higher in the WB cohort (\u221210 vs \u22126, P\u2009&amp;lt;\u20090.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Despite nearly 20\u2009years of combat operations, hypothermia continues to be a challenge in military trauma and is associated with a high mortality rate. Mortality was similar between hypothermic trauma patients resuscitated with WB vs component therapy, despite greater physiologic derangements on arrival in patients who received WB. As the military has the potential to conduct missions in environments where the risk of hypothermia is high, further research into hypothermia mitigation techniques and resuscitation strategies in the deployed setting is warranted.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usae072","type":"journal-article","created":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T05:41:13Z","timestamp":1708148473000},"page":"190-195","source":"Crossref","is-referenced-by-count":4,"title":["Hypothermia and the Global War on Terror: 18 Years of Minimal Progress"],"prefix":"10.1093","volume":"189","author":[{"given":"Luke","family":"Pumiglia","sequence":"first","affiliation":[{"name":"Department of Surgery, Madigan Army Medical Center , Joint Base Lewis-McChord, WA 98431, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Surgery, Madigan Army Medical Center , Joint Base Lewis-McChord, WA 98431, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beau J","family":"Prey","sequence":"additional","affiliation":[{"name":"Department of Surgery, Madigan Army Medical Center , Joint Base Lewis-McChord, WA 98431, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew D","family":"Francis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Madigan Army Medical Center , Joint Base Lewis-McChord, WA 98431, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel T","family":"Lammers","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Alabama Birmingham , Birmingham, AL 35233, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bobby Z","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Madigan Army Medical Center , Joint Base Lewis-McChord, WA 98431, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah M","family":"Palmerton","sequence":"additional","affiliation":[{"name":"Department of Surgery, Madigan Army Medical Center , Joint Base Lewis-McChord, WA 98431, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace E","family":"Pak","sequence":"additional","affiliation":[{"name":"Department of Surgery, Madigan Army Medical Center , Joint Base Lewis-McChord, WA 98431, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer M","family":"Gurney","sequence":"additional","affiliation":[{"name":"Joint Trauma System, DoD Center of Excellence for Trauma , JBSA Fort Sam Houston, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason R","family":"Bingham","sequence":"additional","affiliation":[{"name":"Department of Surgery, Madigan Army Medical Center , Joint Base Lewis-McChord, WA 98431, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M","family":"McClellan","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of North Carolina Chapel Hill , Chapel Hill, NC 27514, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,8,19]]},"reference":[{"issue":"20","key":"2024081914591355500_R1","doi-asserted-by":"publisher","first-page":"1930","DOI":"10.1056\/NEJMra1114208","article-title":"Accidental hypothermia","volume":"367","author":"Brown","year":"2012","journal-title":"N Engl J Med"},{"issue":"1","key":"2024081914591355500_R2","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/S0020-1383(03)00309-7","article-title":"Hypothermia in the trauma patient","volume":"35","author":"Tsuei","year":"2004","journal-title":"Injury"},{"issue":"16","key":"2024081914591355500_R3","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18168719","article-title":"Hypothermia in trauma","volume":"18","author":"van Veelen","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2024081914591355500_R4","article-title":"Registries","author":"Joint Trauma System"},{"issue":"5","key":"2024081914591355500_R5","doi-asserted-by":"publisher","DOI":"10.1097\/01.XCS.0000896448.74106.fe","article-title":"Hypothermia on admission predicts poor outcomes in adult trauma patients","volume":"235","author":"Zeeshan","year":"2022","journal-title":"J Am Coll Surg"},{"issue":"3","key":"2024081914591355500_R6","doi-asserted-by":"publisher","first-page":"97","DOI":"10.4103\/0974-2700.185276","article-title":"Hypothermia as a predictor for mortality in trauma patients at admittance to the intensive care unit","volume":"9","author":"Balvers","year":"2016","journal-title":"J Emerg Trauma Shock"},{"issue":"11","key":"2024081914591355500_R7","doi-asserted-by":"publisher","first-page":"2343","DOI":"10.1016\/j.ajem.2019.11.050","article-title":"An analysis of the incidence of hypothermia in casualties presenting to emergency departments in Iraq and Afghanistan","volume":"38","author":"Fisher","year":"2020","journal-title":"Am J Emerg Med"},{"issue":"7","key":"2024081914591355500_R8","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1080\/10903127.2022.2119315","article-title":"Hypothermia in the combat trauma population","volume":"27","author":"Schauer","year":"2023","journal-title":"Prehosp Emerg Care"},{"issue":"3","key":"2024081914591355500_R9","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1097\/TA.0000000000002144","article-title":"The impact of hypothermia on outcomes in massively transfused patients","volume":"86","author":"Lester","year":"2019","journal-title":"J Trauma Acute Care Surg"},{"issue":"3","key":"2024081914591355500_R10","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1097\/JTN.0000000000000583","article-title":"Trauma prehospital hypothermia prevention and treatment: an observational study","volume":"28","author":"Mota","year":"2021","journal-title":"J Trauma Nurs"},{"issue":"5","key":"2024081914591355500_R11","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1097\/01.ta.0000188647.03665.fd","article-title":"Is hypothermia simply a marker of shock and injury severity or an independent risk factor for mortality in trauma patients? Analysis of a large national trauma registry","volume":"59","author":"Shafi","year":"2005","journal-title":"J Trauma"},{"key":"2024081914591355500_R12","article-title":"Hypothermia Prevention and Management Kit (HPMK)","author":"North American Rescue"},{"issue":"1","key":"2024081914591355500_R13","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1097\/TA.0000000000002498","article-title":"Safety profile and impact of low-titer group O whole blood for emergency use in trauma","volume":"88","author":"Williams","year":"2020","journal-title":"J Trauma Acute Care Surg"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/Supplement_3\/190\/58852578\/usae072.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/Supplement_3\/190\/58852578\/usae072.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T16:23:33Z","timestamp":1724084613000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/189\/Supplement_3\/190\/7735881"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,19]]},"references-count":13,"journal-issue":{"issue":"Supplement_3","published-online":{"date-parts":[[2024,8,19]]},"published-print":{"date-parts":[[2024,8,19]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usae072","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,9]]},"published":{"date-parts":[[2024,8,19]]}}}