Body Temperature as a Predictor of Mortality in Multiple Trauma Patients: A Prospective Single-Centre Cohort Study

Body Temperature as a Predictor of Mortality in Multiple Trauma Patients: A Prospective Single-Centre Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Body Temperature as a Predictor of Mortality in Multiple Trauma Patients: A Prospective Single-Centre Cohort Study Robert Blasco Mariño, Miguel Ángel Gonzalez Posada, Iñigo Soteras Martinez, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7837483/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Jan, 2026 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Background Trauma is the leading cause of death among working-age people. Individuals who have experienced trauma are more susceptible to developing accidental hypothermia. This condition has been demonstrated to be associated with poor clinical outcomes. The primary objective of this study was to identify the association between body temperature (BT) and mortality in patients with multiple trauma. A secondary objective was to ascertain whether this association remained significant in patients experiencing cold stress. Methods A prospective cohort study was conducted in a level-3-trauma centre in Barcelona, Spain, between August 2022 and February 2024. Data pertaining to demographics, out-of-hospital and in-hospital clinical variables were collected. BT was categorised as follows: 37°C. Bivariate and multivariate logistic regression were conducted to assess the association between BT and mortality. A sensitivity analysis was also performed using a dichotomous BT threshold of < 36°C. Results The study comprised 334 patients, with an overall mortality rate of 10.4%. Hypothermia (BT < 35°C) was observed in 11.7% of patients, resulting in a mortality rate of 25%. Patients experiencing cold stress (35–37°C) constituted 75.1% of the cohort. Bivariate logistic regression revealed a significant inverse relationship between BT and mortality (OR 0.51, 95%CI 0.3–0.7; P < 0.001). Following multivariable adjustment, the association remained robust (OR 0.58, 95%CI 0.37–0.91; P = 0.02). A subsequent sensitivity analysis demonstrated that a BT < 36°C was an independent predictor of mortality for patients experiencing cold stress (OR 3.29; 95%CI: 1.23–8.77; P = 0.017). Conclusions BT was identified as an independent and significant predictor of mortality in patients with multiple trauma. For every 1°C decrease in BT, the odds of mortality increased by 72%. Patients who experienced cold stress with a BT < 36°C exhibited a threefold elevated probability of mortality. Clinical trial number: not applicable. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors Hypothermia Multiple trauma Advanced trauma life support care Emergencies Mortality Figures Figure 1 Figure 2 Introduction According to the World Health Organization (WHO), injuries resulting from road traffic crashes, falls, drowning, burns, poisoning, and violence against oneself or others produce 4.4 million deaths worldwide, accounting for nearly 8% of all deaths [ 1 ]. Patients suffering from trauma are predisposed to developing accidental hypothermia, with a prevalence ranging from 40 to 66% in severely injured patients [ 2 , 3 ]. This condition has been demonstrated to be associated with suboptimal clinical outcomes, with an increased mortality rate observed in relation to a decrease in temperature [ 4 , 5 ]. The contributing factors to this increased mortality rate include the characteristics of the injury, environmental conditions, and the medical interventions performed throughout the rescue process [ 6 ]. Accidental hypothermia is defined as a drop in the core temperature to below 35°C [ 7 ]. Core temperature (CT) is defined as the internal temperature measured with invasive probes (e.g. oesophageal or bladder), whereas body temperature (BT) is usually measured in the axilla or on the forehead [ 8 ]. In some scenarios, BT measurement may be the only way to obtain a reading (e.g. in awake or non-cooperative patients, with lack of tympanic thermistor probes or facial or skull trauma or emergency situations). Patients exhibiting symptoms consistent with cold stress are characterized by a core temperature ranging from 35 to 37°C, with the absence of indications of hypothermia [ 9 ]. In instances where the drop in temperature is a consequence of trauma, some experts delineate accidental hypothermia as a core temperature of less than 36°C [ 10 – 12 ]. This threshold is consistent with recommendations from military trauma systems, such as the Joint Trauma System of the US Department of Defense [ 13 ]. In a multitude of medical centres, particularly those situated in moderate climates, there is often an underestimation of core temperature alterations in trauma patients. This is frequently attributable to delayed temperature measurement, inadequate probes for measuring deep core temperature, or limited awareness in trauma activation protocols [ 6 ]. Patients suffering from both injuries and hypothermia have been shown to exhibit poorer outcomes and a higher risk of chronic critical illness in comparison to those experiencing hypothermia resulting from environmental exposure alone [ 14 ]. The question of whether hypothermia independently worsens outcomes or is a marker of injury severity remains a subject of debate in observational studies [ 4 , 5 , 15 – 18 ]. The heterogeneity of the study designs, patient selection, hypothermia definitions, and the timing and location of temperature measurement, in addition to the varying approaches to modelling confounding variables, complicates the ability to draw definitive conclusions about mortality. It is imperative to recognize that the absence of diagnostic and therapeutic measures for BT decrease is not substantiated by the condition's status as a modifiable, preventable, and treatable condition. The objective of this study was to ascertain the independent relationship between BT and mortality in patients with multiple trauma, while accounting for confounders. A secondary objective was to ascertain the validity of this association in patients experiencing cold stress. Methods Design and patient selection A prospective cohort study was conducted at the Vall d'Hebron University Hospital Trauma Centre in Barcelona, Spain. A sample size calculation was performed a priori to ensure adequate statistical power. Based on published literature mortality rate [5,17] and our centre’s historical mortality rates, the study was powered to detect a mortality difference of 10% between hypothermic and normothermic patients with 80% power at a two-sided α of 0.05, using a two-sample test for proportions. This yielded a target sample of approximately 300 patients. The study period enrolled all eligible polytrauma patients at Vall d’Hebron University Hospital Trauma Centre between 31 August 2022 and 28 February 2024 until the target sample size was reached. Vital signs were obtained within the first minutes of patient arrival, and the initial time of care served as confirmation. Out-of-hospital temperature measurement was conducted by means of an infrared thermometer of the Riester Ri-thermo® N tympanic thermometer (Riester GmbH & Co. KG, Jungingen, Germany). The measurement of in-hospital temperature was conducted in accordance with our established protocol for BT measurement. For patients without a protected airway, an axillary reading was obtained using a Filac ADA 3000 thermometer (Covidien, Cornellà de Llobregat, Spain). In patients with a protected airway, the core temperature was measured using a bladder probe (Mon-a-ThermTM 400TM, Covidien, Degania, Israel) or an esophageal probe (Level 1TM Esophageal/Rectal Temperature Probe, ER400-12, 12FR, ICU Medical, Minneapolis, USA). This result was included in the initial vital signs record. The BT sample was categorized into the following groups: the temperature range is from <35°C, 35 to 35.9°C, 36 to 36.9°C, and from 37°C and above. Inclusion criteria The inclusion criteria encompassed patients over the age of 18 years who met the criteria for activation of multiple trauma codes and were classified as SET 1 (immediate care) according to the Spanish Triage System (SET) [19]. Data collection Data of multiple trauma patients was collected via the out- and in-hospital patient data management system (REDCap® system [20]) into a standardized protocol. The data were entered consecutively for each patient activation. Subsequently, these cases were reviewed by an independent reviewer who also conducted in-hospital follow-ups. A second reviewer conducted a follow-up period of a minimum of six months and verified the database prior to analysis. Study variables The following demographic data were collected out-of-hospital: age, sex, medical history, and American Society of Anesthesiologists (ASA) classification. Out-of-hospital data from Emergency Medical Services (EMS) were documented in accordance with the patient's medical record and handover information, encompassing the season of the year, transport type, neurological status, temperature measurement, mechanism of injury, necessity for pharmaceutical interventions and airway management. The following data has been sourced from in-hospital records: Vital signs at hospital arrival, a neurological examination and initial resuscitation measures. Diagnostic tests (e.g. CT scan, laboratory results), initial measures to prevent hypothermia, Injury Severity Score (ISS), activation of the massive haemorrhage protocol and time of initial critical care. Survival and mortality with a minimum follow-up period of six months. Statistical analysis Categorical variables are described using absolute frequencies (n) and relative frequencies (%). Continuous variables with a normal distribution were described using the mean and standard deviation (SD), while those without a normal distribution were described using the median and interquartile range (IQR). The assessment of normality was conducted through the utilization of the Shapiro–Wilk test and Q–Q plots. To estimate the association between BT and mortality, bivariate and multivariable logistic regression models were developed. Potential confounders, selected on the basis of biological plausibility and their impact on the odds ratio of BT (>15% variability), were included in the multivariable logistic regression models [21]. . To circumvent the issue of collinearity, the Variance Inflation Factor (VIF) was evaluated for each variable. The final model was selected based on the Akaike Information Criterion (AIC), with the lowest value indicating the best fit. The adequacy of the model was evaluated using goodness-of-fit tests, with the area under the curve (AUC) serving as a measure of predictive ability. The results were expressed as odds ratios (OR) and 95% confidence intervals (95% CI), with P < 0.05 indicating statistical significance. To analyse the relationship between BT and mortality among patients experiencing cold stress, a dichotomous variable was created based on a threshold of 36°C to assess the stability of this association. To address the potential heterogeneity in temperature measurement, a dichotomous variable distinguishing between core and peripheral readings was included in all multivariate models. The aim of this was to assess whether the type of measurement influenced the association of BT with mortality. All analyses were conducted using R (version 4.4.1; R Core Team, 2024). Ethical considerations The study was conducted in accordance with the principles of the Declaration of Helsinki for research involving human participants and was approved by the Hospital Research Ethics Committee (CEIC) of the Hospital Universitario Vall d'Hebron. This study was approved by the CEIC (Protocol PR(AT)164/2022, initial approval date 03/05/2022). An amendment granting a waiver of informed consent for the emergency enrolment of multiple trauma patients was subsequently approved on 25/05/2023, based on the impracticability of obtaining individual consent after patient discharge. All patient data were coded for analysis, ensuring confidentiality, and all procedures complied local data protection regulations. The confidentiality and privacy of the data were guaranteed in accordance with the provisions of Spanish Organic Law 3/2018 of 5 December on Data Protection and Digital Rights Guarantees (LOPDPGDD). The present study is in accordance with the STROBE guidelines [22]. Results The study comprised a total of 334 patients. Of these, 39 (11.7%) presented with hypothermia (BT< 35°C), and 251 (75.1%) with cold stress (BT 35-37ºC). Of the patients experiencing cold stress, 106 (42.2%) exhibited a BT ranging from 35 to 35.9°C, while 145 (57.8%) demonstrated a BT between 36 and 37°C ( Table 1 ). The demographic profile of the patient population is characterized by a predominance of males, accounting for 80% of cases, with a mean age of 43.1 years. Out-of-hospital BT was measured in 28.5% of admitted patients, with a median value of 36°C (35-36°C). Regarding out-of-hospital interventions, 21.9% of patients required airway management, and epinephrine infusion was initiated in 11.7% of cases. An analysis of transport-related data revealed that 25.8% of patients were transferred by helicopter, 42.2% were admitted during the night, and 29.9% during the winter months. The most prevalent mechanisms of injury were falls (32.7%) and motorbike accidents (15.9%). In-hospital temperature was measured in 100% of patients, with a median temperature of 36.1°C (35.5–36.5°C) ( Table 2 ). Upon hospital arrival, 59.7% of the cohort presented with acidosis. Spinal injuries were the most prevalent diagnosis (40.6%). The utilization of rewarming air blankets was observed in 63.9% of the patients, while core temperature measurement was conducted in 28.6% of patients. The core temperature probe was inserted in 85% of patients with airway protection, in accordance with our established protocol. Mortality Six patients were excluded from the mortality analysis due to incomplete follow-up periods. The overall mortality rate was 10.4%. Patients with hypothermia exhibited a mortality rate of 25%, while those experiencing cold stress demonstrated a mortality rate of 12.3% when their BT ranged from 35°C to 35.9°C and 8.4% when their BT was between 36°C and 37°C. Univariate logistic regression analysis of BT and mortality demonstrated a statistically significant association (OR 0.51, 95% CI 0.3-0.7; P< 0.001) ( Table 3 ). Following adjustment for ISS, ASA classification (I–II vs. III–IV), and out-of-hospital GCS <9 in a multivariate regression model, BT remained a significant independent predictor of mortality (OR 0.58, 95% CI: 0.37–0.91; P=0.020). The marginal effects demonstrated an inverse relationship between BT and mortality ( Figure 1 ). The present study found an association between an increase in BT from 35°C to 36°C and a 6.74% decrease in the probability of mortality. The probability of mortality decreased from 18.3% (95% CI: 10% – 31%) to 11.6% (95% CI: 6.5% – 19%). In a similar manner, an increase from 36°C to 37°C was associated with a 4.5% decrease in the probability of mortality, from 11.6% (95% CI: 6.5%-19.6%) to 7.1% (95% CI: 3.2% - 14%). The association between BT and mortality persisted even when the CT variable was considered (OR 0.56, 95% CI 0.35-0.89, P=0.015). In conclusion, the model under scrutiny exhibited good discriminative ability, as evidenced by an area under the curve (AUC) value of 0.923. Body temperature sub-analysis at < 36ºC BT was dichotomized using a threshold of <36 °C to assess its association with mortality in a sensitivity analysis for patients experiencing cold stress. In univariable logistic regression, a temperature of <36 °C was found to be significantly associated with a crude OR of 2.65 (95% CI: 1.26–5.57; P=0.01). The association remained robust after multivariable adjustment using the previously described logistic regression model (OR 3.29; 95% CI: 1.23–8.77; P=0.017) ( Table 4 ). For each ISS value, patients with a body temperature below 36°C consistently exhibit a higher probability of mortality compared to those with a temperature of 36°C or above ( Figure 2 ). The observed association between BT and mortality remained consistent following the inclusion of a CT variable (OR 3.71; 95% CI: 1.34–10.26; P=0.011). The discriminative ability of the model, utilizing the BT < 36ºC threshold, was 0.928 (AUC). Discussion The present study demonstrates an independent association between a decrease in BT and increased mortality in multiple trauma patients. The inverse relationship between BT and mortality was evident across the entire cohort, with every 1°C decrease in BT resulting in a 72% increase in the odds of mortality. Whilst the present association is both consistent and clinically relevant, the observational design does not permit the establishment of a direct causal relationship. The present study's finding of a significant association between a BT < 36°C and mortality in cold-stressed patients challenges the traditional view that only hypothermia is a concern. The findings of this study demonstrate that when two patients are compared suffering from cold-stress and multiple trauma, and the ISS, ASA classification, and out-of-hospital GCS < 9 are found to be equal, the probability of death is threefold higher for the patient with a BT below 36°C. This finding serves to reinforce the notion that even a mild drop in temperature is not merely a marker of injury severity, but rather an independent risk factor for mortality [ 12 , 23 ]. The area under the curve (AUC) of this model using BT < 36°C was 0.928, indicating an adequate adjustment for confounding factors and a high discriminatory capacity. If the model had been affected by significant residual confounding, its discriminatory power would have been reduced, resulting in a lower AUC. Should significant residual confounding have been present, it would have served to diminish the model's discriminative capacity. This would have resulted in a lower AUC. This finding is of particular interest in light of the recently updated ATLS 2025 version, which defines trauma hypothermia as a core temperature below 35ºC instead of 36ºC [ 24 ]. This stands in contrast to the European Trauma Course manual (2018 version), which advises maintaining a BT above 36ºC in traumatic shock patients [ 25 ]. It is well-documented that patients with multiple traumas exhibit cardiovascular, neurological, respiratory and haematological dysfunctions, as well as increased mortality, when exposed to temperatures of 36°C or lower [ 11 , 12 , 23 , 26 , 27 ]. Lester et al. demonstrated that for each degree below 36°C, there was a 10% increase in packed red blood cell consumption within the initial 24 hours [ 2 ]. The prevalence of hypothermia (11.7%) and cold stress (75.1%) in our cohort, despite the generally warm climate in the Catalunya region, Spain, where the accidents occurred, highlights the need for proactive thermal monitoring and intervention. Our data challenge the common misconception that hypothermia is only a seasonal concern [ 28 ], as over half of our hypothermic patients (56.4%) arrived outside of the winter season. This is consistent with national data, which shows that 64.7% of fatal hypothermia accidents occurred outside of winter in Spain[ 29 ]. Since the clinical presentation of hypothermia can mimic other common trauma conditions, standardized protocols are crucial to prevent it from being missed at any point in the rescue chain. In our cohort, 100% of patients had their temperature measured in the emergency department, while the out-of-hospital measurement rate was 25%. Non-adherence to temperature recording is a global issue and is not specific to temperate climates [ 5 , 30 ]. In the German Trauma Registry DGU, 69% of records had missing temperature data [ 17 ]. The failure to measure temperature is associated with increased hospital mortality [ 30 ]. Furthermore, a significant shortcoming of scientific publications on hypothermia and trauma is the frequent omission of information on the method used to measure BT [ 17 , 23 , 31 – 34 ]. Hypothermia is often overlooked in current training and education, and appropriate measurement and temperature management equipment may not be used in the out-of-hospital and in-hospital area, especially when the accident circumstances do not suggest the presence of cold stress or hypothermia. Our data support the implementation of BT measurement protocols and early rewarming strategies as a primary quality-of-care indicator in EMS and trauma centres. As a modifiable factor that directly influences survival, it is essential that we emphasize the importance of preventing BT decrease. Limitations Our study is single-centre. This limits the external validity of our findings. Due to the observational nature of the study, we cannot establish a direct causal relationship between hypothermia and mortality. Variability in the temperature measurement site, with 28.4% of initial measurements being core temperatures, may contribute to data heterogeneity. However, this measurement error is unlikely to obscure the overall trend. To address this potential bias, a dichotomous variable distinguishing between core and peripheral measurements was included in our regression model. This analysis demonstrated that, after adjusting for this variable, the BT remained a significant predictor of mortality. In our registry, there were limited numbers of patients with extreme temperature values, meaning that most of the study sample was concentrated within a relatively narrow temperature range (Table 2 ). However, all measurements were taken within the first few minutes of hospital care by staff trained in hypothermia management. Our sample size is limited, which affects the adjustment of some covariables and their generalizability. We did not consider complications associated with a longer hospital stay, such as days of mechanical ventilation, infections, renal failure, or myopathy. Conclusions In this study, a decrease in BT was found to be an independent and significant predictor of mortality in multiple trauma patients. For every 1ºC decrease in the BT, the odds of mortality increased by 72%. A BT threshold of < 36ºC was also identified as a significant predictor of mortality in cold-stressed patients. Cold-stressed patients with a BT < 36°C had a threefold higher probability of death compared to those with the same ISS, ASA classification, and out-of-hospital GCS < 9. Declarations Acknowledgments: DeepL software (DeepL SE, Cologne, Germany) for language editing of the manuscript. Authors contribution: RB: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Resources; Software; Supervision; Validation; Visualization; Writing – original draft. MA: Validation; Visualization; Writing – original draft. IS: Methodology; Supervision; Validation; Visualization; Writing – original draft. JM: Data curation; Software; Validation; Writing – review & editing. NJ: Validation; Writing – review & editing. PP: Methodology; Supervision; Validation; Visualization; Writing – review & editing. AB: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Resources; Software; Supervision; Validation; Visualization; Writing – review & editing. Data availability: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request Clinical trial number: not applicable. Ethics approval Ethical approval for this study was granted by the Ethics Committee of the Vall d’Hebron University Hospital in Barcelona, Spain (reference number PR(AT)164/2022), and all study procedures were performed in accordance with the principles of the Declaration of Helsinki. Consent for publication Enrolment and data use followed a full waiver of informed consent approved by the CEIC (Protocol PR(AT)164/2022). Competing interests We adhere to ICMJE and COPE guidelines and have no conflicts of interest to disclose. Conflict of Interest/Funding Statement: The authors declare no conflicts of interest or sources of funding to disclose. Ethics Statement: The authors declare that they have the Clinical Research Ethics Committee authorization for this study and the entire sturdy conducted in accordance with the principles of the Declaration of Helsinki. Originality Statement: This work is original and has not been published in any other journal. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request References Injuries and violence [Internet]. [Cited on 6 October 2025.]. https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence. Access 6 oct 2025 Lester E, Fox E, Holcomb J, Brasel K, Bulger E, Cohen M, et al. The impact of hypothermia on outcomes in massively transfused patients. J Trauma Acute Care Surg. 2019;86:458-63. https://doi.org/10.1097/TA.0000000000002144 Winkelmann M, Soechtig W, Macke C, Schroeter C, Clausen JD, Zeckey C, et al. Accidental hypothermia as an independent risk factor of poor neurological outcome in older multiply injured patients with severe traumatic brain injury: a matched pair analysis. Eur J Trauma Emerg Surg. 2019;45:255-61. https://doi.org/10.1007/s00068-017-0897-0 Martin RS, Kilgo PD, Miller PR, Hoth JJ, Meredith JW, Chang MC. INJURY-ASSOCIATED HYPOTHERMIA: AN ANALYSIS OF THE 2004 NATIONAL TRAUMA DATA BANK: Shock. 2005;24:114-8. https://doi.org/10.1097/01.shk.0000169726.25189.b1 Azarkane M, Rijnhout TWH, van Merwijk IAL, Tromp TN, Tan ECTH. Impact of accidental hypothermia in trauma patients: A retrospective cohort study. Injury. M. Azarkane, Department of Trauma Surgery, Geert Grooteplein Zuid 10, GA Nijmegen, Netherlands; 2024;55. https://doi.org/10.1016/j.injury.2023.110973 Søreide K. Clinical and translational aspects of hypothermia in major trauma patients: From pathophysiology to prevention, prognosis and potential preservation. Injury. 2014;45:647-54. https://doi.org/10.1016/j.injury.2012.12.027 Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021;161:152-219. https://doi.org/10.1016/j.resuscitation.2021.02.011 Strapazzon G, Procter E, Paal P, Brugger H. Pre-Hospital Core Temperature Measurement in Accidental and Therapeutic Hypothermia. High Alt Med Biol. Mary Ann Liebert, Inc., publishers; 2014;15:104-11. https://doi.org/10.1089/ham.2014.1008 Accidental hypothermia in adults: Clinical manifestations and evaluation. UpToDate. Updated Mar 14, 2025. [citado 10 de septiembre de 2025]; https://www.uptodate.com/contents/accidental-hypothermia-in-adults-clinical-manifestations-and-evaluation. Accedido 10 sep 2025 Jurkovich GJ. Environmental Cold-Induced Injury. Surg Clin North Am. 2007;87:247-67. https://doi.org/10.1016/j.suc.2006.10.003 Perlman R, Callum J, Laflamme C, Tien H, Nascimento B, Beckett A, et al. A recommended early goal-directed management guideline for the prevention of hypothermia-related transfusion, morbidity, and mortality in severely injured trauma patients. Crit Care. 2016;20:107. https://doi.org/10.1186/s13054-016-1271-z Arthurs Z, Cuadrado D, Beekley A, Grathwohl K, Perkins J, Rush R, et al. The impact of hypothermia on trauma care at the 31st combat support hospital. Am J Surg. 2006;191:610-4. https://doi.org/10.1016/j.amjsurg.2006.02.010 Joint Trauma System. Hypothermia: Prevention and Treatment. CPG ID: 23. 07 Jun 2023. Accessed September 10, 2025. Miranda D, Maine R, Cook M, Brakenridge S, Moldawer L, Arbabi S, et al. Chronic critical illness after hypothermia in trauma patients. Trauma Surg Acute Care Open. J. Cuschieri, Surgery at Zsfg, University of California San Francisco, San Francisco, CA, United States; 2021;6. https://doi.org/10.1136/tsaco-2021-000747 Ireland S, Endacott R, Cameron P, Fitzgerald M, Paul E. The incidence and significance of accidental hypothermia in major trauma—A prospective observational study. Resuscitation. 2011;82:300-6. https://doi.org/10.1016/j.resuscitation.2010.10.016 Shafi S, Elliott AC, Gentilello L. 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. J Trauma Inj Infect Crit Care. S. Shafi, Department of Surgery, Division of Burn, Trauma and Surgical Critical Care, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9158, United States; 2005;59:1081-5. https://doi.org/10.1097/01.ta.0000188647.03665.fd Trentzsch H, Huber-Wagner S, Hildebrand F, Kanz K-G, Faist E, Piltz S, et al. Hypothermia for prediction of death in severely injured blunt trauma patients. Shock. H. Trentzsch, Department of Surgery, Hospital of the University of Munich, Campus Großhadern, Marchioninistr. 15, 81377 Munich, Germany; 2012;37:131-9. https://doi.org/10.1097/SHK.0b013e318245f6b2 Wang HE, Callaway CW, Peitzman AB, Tisherman SA. Admission hypothermia and outcome after major trauma: Crit Care Med. 2005;33:1296-301. https://doi.org/10.1097/01.CCM.0000165965.31895.80 Gómez Jiménez J, editor. Sistema Estructurado de Triaje - SET: Manual de implementación. Andorra: Esbarzer S.L. ,Treelogic S.L.; 2015. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208. https://doi.org/10.1016/j.jbi.2019.103208 Hosmer DW, Lemeshow S, Sturdivant RX. Applied Logistic Regression. 3a edición. Wiley; 2013. Elm E von, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. The Lancet. Elsevier; 2007;370:1453-7. https://doi.org/10.1016/S0140-6736(07)61602-X Okada A, Okada Y, Narumiya H, Ishii W, Kitamura T, Iiduka R. Body temperature and in-hospital mortality in trauma patients: analysis of a nationwide trauma database in Japan. Eur J TRAUMA Emerg Surg. 2022;48:163-71. https://doi.org/10.1007/s00068-020-01489-9 American College of Surgeons Committee on Trauma. Advanced Trauma Life Support (ATLS): Student Course Manual. 11th ed. Chicago, IL: American College of Surgeons; 2025. European Trauma Course Manual. The team approach. 4th ed. European Trauma Course Organisation (ETCO) ivzw; 2018. p. 70. Waibel BH, Schlitzkus LL, Newell MA, Durham CA, Sagraves SG, MF R. Impact of hypothermia (below 36 degrees C) in the rural trauma patient. J Am Coll Surg. United States: Department of Surgery, Division of Trauma and Surgical Critical Care, The Brody School of Medicine, East Carolina University, Greenville, NC, USA.; 2009;209:580-8. https://doi.org/10.1016/j.jamcollsurg.2009.07.021 Eisenhauer I, April MD, Rizzo JA, Fisher AD, Maddry JK, Bebarta VS, et al. Seasonal Association With Hypothermia in Combat Trauma. Mil Med. 2023; https://doi.org/10.1093/milmed/usad451 Blasco Mariño, Robert, Soteras Martínez I. Manejo clínico de la hipotermia accidental – Revista Emergencias. 35:69-71. Blasco Mariño R, Argudo E, Soteras Martinez I. Antes y después de la primera reanimación cardiopulmonar extracorpórea por hipotermia accidental en España. Med Intensiva. Elsevier; 2024;48:551-4. https://doi.org/10.1016/j.medin.2024.05.021 Alam A, Olarte R, Nascimento B, Laflamme C, Tien H, Callum J. A retrospective quality audit regarding the incidence and treatment of hypothermia in severely injured trauma patients who undergo emergent surgery. CMAJ Can Med Assoc J. A. Alam, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 2016;59:S26. https://doi.org/10.1503/cjs.006816 Rubiano AM, Sanchez AI, Estebanez G, Peitzman A, Sperry J, Puyana JC. The effect of admission spontaneous hypothermia on patients with severe traumatic brain injury. Injury. 2013;44:1219-25. https://doi.org/10.1016/j.injury.2012.11.026 Weuster M, Brück A, Lippross S, Menzdorf L, Fitschen-Oestern S, Behrendt P, et al. Epidemiology of accidental hypothermia in polytrauma patients: An analysis of 15,230 patients of the TraumaRegister DGU. J Trauma Acute Care Surg. 2016;81:905-12. https://doi.org/10.1097/TA.0000000000001220 Klauke N, Gräff I, Fleischer A, Boehm O, Guttenthaler V, Baumgarten G, et al. Effects of prehospital hypothermia on transfusion requirements and outcomes: A retrospective observatory trial. BMJ Open [Internet]. M. Wittmann, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany; 2016;6. https://doi.org/10.1136/bmjopen-2015-009913 Thompson HJ, Kirkness CJ, Mitchell PH. Hypothermia and Rapid Rewarming Is Associated With Worse Outcome Following Traumatic Brain Injury. J Trauma Nurs. 2010;17:173-7. https://doi.org/10.1097/JTN.0b013e3181ff272e Tables Table 1. Out-of-hospital characteristics of multiple trauma patients stratified by admission body temperature. BT: body temperature. ASA: American Society of Anesthesiologists physical status classification. GCS: Glasgow Coma Scale. Data are presented as number (percentage) for categorical variables, mean (standard deviation, SD) for normally distributed continuous variables, and median (interquartile range, IQR) for non-normally distributed continuous. variables. Out-of-hospital BT refers to temperature recorded before hospital arrival. Table 2. Clinical characteristics and in-hospital outcome of multiple trauma patients stratified by admission body temperature. BT: Body temperature. ASA: American Society of Anesthesiologists physical status classification. GCS: Glasgow Coma Scale. HR: heart rate. RR: respiratory rate. SBP: Systolic blood pressure. DBP: Diastolic blood pressure. ISS: Injury Severity Score, TBI: Traumatic brain injury. Data are presented as number (percentage) for categorical variables, mean (standard deviation) for normally distributed continuous variables, and median (interquartile range) for non-normally distributed continuous variables. * Airway management for surgery during initial care was not included, only airway protection on admission due to severity or clinical evaluation. Table 3. Univariate and multivariate logistic regression for assessing the association between mortality and BT AIC 132, Nagelkerke R2 0.532, AUC 0.923. Crude OR shows the association in the univariate analysis. Multivariate regression shows the OR of BT adjusted by ISS, ASA (I-II vs III-IV), CT (yes/no), and out-of-hospital GCS <9. OR = odds ratio; 95% CI = 95% confidence interval; P = P-value; ISS = Injury Severity Score; ASA = American Society of Anesthesiologists; GCS = Glasgow Coma Scale, BT = Body temperature, CT = Core temperature. BT at admission OR (CI 95%) P -value Crude OR 0.51 (0.3 - 0.7) <0.001 Adjusted OR 0.58 (0.37 – 0.91) 0.020 Adjusted OR including CT 0.56 (0.35 - 0.89) 0.015 Table 4. Univariate and multivariable logistic regression analysis of BT dichotomized at <36ºC and mortality. This table represents a sensitivity analysis for cold-stressed patients to assess the stability of the association between body temperature and mortality. Multivariate regression shows the OR of BT adjusted by ISS, ASA (I-II vs III-IV), CT (yes/no), and out-of-hospital GCS <9. AIC 131, Nagelkerke R2 0.536, AUC 0.928. OR = odds ratio; 95% CI = 95% confidence interval; P = P-value; ISS = Injury Severity Score; ASA = American Society of Anesthesiologists; GCS = Glasgow Coma Scale, BT = Body temperature, CT = Core temperature. BT at admission < 36ºC OR (CI 95%) P -value Crude OR 2.65 (1.26 - 5.57) 0.01 Adjusted OR 3.29 (1.23 – 8.77) 0.017 Adjusted OR including CT 3.71 (1.34 - 10.26) 0.011 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Jan, 2026 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 17 Dec, 2025 Reviews received at journal 08 Dec, 2025 Reviewers agreed at journal 08 Dec, 2025 Reviews received at journal 28 Nov, 2025 Reviewers agreed at journal 28 Nov, 2025 Reviewers invited by journal 29 Oct, 2025 Editor assigned by journal 29 Oct, 2025 Editor invited by journal 23 Oct, 2025 Submission checks completed at journal 17 Oct, 2025 First submitted to journal 17 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7837483","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":541890833,"identity":"baf5195e-ff64-4648-893f-585741d4d4b7","order_by":0,"name":"Robert Blasco Mariño","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYFACHsYDYFqCGURLyBCjhQGqhS0BRPKQooXHAMIlBMzbew8c+PHHjsF8ds/nVzdqLHgY2A8f3YBPi8yZcwkHe9uSGWTunN1mnXMM6DCetLQb+LRISOQYHOBtOABk5G4zzmEDapHgMSOo5eCfPyAtOc+Mc/4RqeUwDxtYC/Pj3DZitPCcSzgs25bMIyFzzIw5t0+Ch42gX9h7Dz5888dOTkK6+fHnnG91cvzsh4/h1QIDoOhgkwCx2IhRDgPMH0hRPQpGwSgYBSMHAACYs0OBAPwlTgAAAABJRU5ErkJggg==","orcid":"","institution":"Autonomous University of Barcelona","correspondingAuthor":true,"prefix":"","firstName":"Robert","middleName":"Blasco","lastName":"Mariño","suffix":""},{"id":541890837,"identity":"49dd0bd1-67e8-4040-8611-d583ae30c555","order_by":1,"name":"Miguel Ángel Gonzalez Posada","email":"","orcid":"","institution":"Autonomous University of Barcelona","correspondingAuthor":false,"prefix":"","firstName":"Miguel","middleName":"Ángel Gonzalez","lastName":"Posada","suffix":""},{"id":541890838,"identity":"4e7530ae-ba76-4045-b8f3-6a35c612e059","order_by":2,"name":"Iñigo Soteras Martinez","email":"","orcid":"","institution":"University of Girona","correspondingAuthor":false,"prefix":"","firstName":"Iñigo","middleName":"Soteras","lastName":"Martinez","suffix":""},{"id":541890839,"identity":"a47bfea9-a377-4377-b97b-b284d3ced742","order_by":3,"name":"Jose María Vazquez Reverón","email":"","orcid":"","institution":"Vall d’Hebron University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jose","middleName":"María Vazquez","lastName":"Reverón","suffix":""},{"id":541890840,"identity":"47b5fcb4-fe48-48c9-848d-b020bfa42371","order_by":4,"name":"Nayana Joshi Jubert","email":"","orcid":"","institution":"Autonomous University of Barcelona","correspondingAuthor":false,"prefix":"","firstName":"Nayana","middleName":"Joshi","lastName":"Jubert","suffix":""},{"id":541890841,"identity":"80340a96-bee9-4d98-b86b-cdc132b9fcd0","order_by":5,"name":"Peter Paal","email":"","orcid":"","institution":"St. John of God Hospital, Paracelsus Medical University","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"","lastName":"Paal","suffix":""},{"id":541890842,"identity":"9cc4d306-9219-4ace-88d6-ab04bc41025b","order_by":6,"name":"Alfonso Biarnés Suñé","email":"","orcid":"","institution":"Autonomous University of Barcelona","correspondingAuthor":false,"prefix":"","firstName":"Alfonso","middleName":"Biarnés","lastName":"Suñé","suffix":""}],"badges":[],"createdAt":"2025-10-11 21:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7837483/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7837483/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-026-35372-1","type":"published","date":"2026-01-24T15:59:22+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":95565545,"identity":"5df11f31-dea5-4589-b2e5-6397508b9cf2","added_by":"auto","created_at":"2025-11-10 16:16:40","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":251850,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscriptRBrev.docx","url":"https://assets-eu.researchsquare.com/files/rs-7837483/v1/85d7a2e9ed260c5270487ccc.docx"},{"id":95565548,"identity":"378e8a7d-d96e-4ca0-a87e-8b4c01a97744","added_by":"auto","created_at":"2025-11-10 16:16:40","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9260,"visible":true,"origin":"","legend":"","description":"","filename":"3ee4431429354bec88349c52d5b6859e.json","url":"https://assets-eu.researchsquare.com/files/rs-7837483/v1/d29c253690a5aa827f2582a8.json"},{"id":95565547,"identity":"74ebeddd-df8d-40fc-a91b-fb796ff33fd1","added_by":"auto","created_at":"2025-11-10 16:16:40","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":111413,"visible":true,"origin":"","legend":"","description":"","filename":"3ee4431429354bec88349c52d5b6859e1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7837483/v1/33845411c62b2f8f48ef225d.xml"},{"id":95654903,"identity":"2ea0d679-bef6-41af-9d53-cb496bb8f839","added_by":"auto","created_at":"2025-11-11 16:13:45","extension":"jpeg","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":27415,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7837483/v1/302d1dd8cd1a8bb16b739001.jpeg"},{"id":95565543,"identity":"ef1e8509-b73b-47c8-953d-b86751e808ca","added_by":"auto","created_at":"2025-11-10 16:16:40","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":131075,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7837483/v1/ef6b7db42402a446b8041938.png"},{"id":95654930,"identity":"d2e779df-a0f8-49c1-9c95-7cd303e7b2b3","added_by":"auto","created_at":"2025-11-11 16:13:50","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":11570,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7837483/v1/7d47291c44cdb0704b982e70.png"},{"id":95654651,"identity":"4a78e0e8-d1a7-4480-8886-e2eff2781546","added_by":"auto","created_at":"2025-11-11 16:12:39","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":13278,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7837483/v1/c8f776a3682341ab9cddc20c.png"},{"id":95565550,"identity":"6251241c-4a29-42ba-969e-896068e2ab8c","added_by":"auto","created_at":"2025-11-10 16:16:40","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":109407,"visible":true,"origin":"","legend":"","description":"","filename":"3ee4431429354bec88349c52d5b6859e1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7837483/v1/2009d1795c4a9afc14b3a398.xml"},{"id":95565551,"identity":"cf41fb7b-21dd-4979-bc77-e94f783f5846","added_by":"auto","created_at":"2025-11-10 16:16:40","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":118817,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7837483/v1/281514768b8b7513bb8d7d88.html"},{"id":95565541,"identity":"e35784f6-865f-470c-b508-d3850a9ba0ff","added_by":"auto","created_at":"2025-11-10 16:16:39","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":27415,"visible":true,"origin":"","legend":"\u003cp\u003eMortality according to the initial BT in the multivariate logistic regression. The line stratifies the temperature values, and the confidence intervals are represented as shaded areas of blue colour. BT = Body temperature.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7837483/v1/192f7993f5ad4a02bbc64362.jpeg"},{"id":95654724,"identity":"c6f65afd-c76d-4436-b111-1128777c20ff","added_by":"auto","created_at":"2025-11-11 16:12:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":131075,"visible":true,"origin":"","legend":"\u003cp\u003eMarginal probability of mortality by body temperature threshold (\u0026lt;36ºC) and ISS. The lines stratify the temperature values (blue for BT \u0026lt;36ºC and red for BT ≥36ºC), representing the probability of death for different ISS values. The confidence intervals are represented as shaded areas of each colour. \u003cem\u003eISS = Injury Severity Score; BT = Body temperature.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7837483/v1/8084e0acbd50bf94d62ca5d8.png"},{"id":101152938,"identity":"4d58db4b-14ea-46fb-8d7c-a7d69467408a","added_by":"auto","created_at":"2026-01-26 16:13:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":911357,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7837483/v1/8cc3929a-ec46-4b2c-847e-a486c0253d02.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Body Temperature as a Predictor of Mortality in Multiple Trauma Patients: A Prospective Single-Centre Cohort Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to the World Health Organization (WHO), injuries resulting from road traffic crashes, falls, drowning, burns, poisoning, and violence against oneself or others produce 4.4\u0026nbsp;million deaths worldwide, accounting for nearly 8% of all deaths [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Patients suffering from trauma are predisposed to developing accidental hypothermia, with a prevalence ranging from 40 to 66% in severely injured patients [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This condition has been demonstrated to be associated with suboptimal clinical outcomes, with an increased mortality rate observed in relation to a decrease in temperature [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The contributing factors to this increased mortality rate include the characteristics of the injury, environmental conditions, and the medical interventions performed throughout the rescue process [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccidental hypothermia is defined as a drop in the core temperature to below 35\u0026deg;C [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Core temperature (CT) is defined as the internal temperature measured with invasive probes (e.g. oesophageal or bladder), whereas body temperature (BT) is usually measured in the axilla or on the forehead [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In some scenarios, BT measurement may be the only way to obtain a reading (e.g. in awake or non-cooperative patients, with lack of tympanic thermistor probes or facial or skull trauma or emergency situations). Patients exhibiting symptoms consistent with cold stress are characterized by a core temperature ranging from 35 to 37\u0026deg;C, with the absence of indications of hypothermia [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In instances where the drop in temperature is a consequence of trauma, some experts delineate accidental hypothermia as a core temperature of less than 36\u0026deg;C [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This threshold is consistent with recommendations from military trauma systems, such as the Joint Trauma System of the US Department of Defense [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn a multitude of medical centres, particularly those situated in moderate climates, there is often an underestimation of core temperature alterations in trauma patients. This is frequently attributable to delayed temperature measurement, inadequate probes for measuring deep core temperature, or limited awareness in trauma activation protocols [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Patients suffering from both injuries and hypothermia have been shown to exhibit poorer outcomes and a higher risk of chronic critical illness in comparison to those experiencing hypothermia resulting from environmental exposure alone [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The question of whether hypothermia independently worsens outcomes or is a marker of injury severity remains a subject of debate in observational studies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The heterogeneity of the study designs, patient selection, hypothermia definitions, and the timing and location of temperature measurement, in addition to the varying approaches to modelling confounding variables, complicates the ability to draw definitive conclusions about mortality.\u003c/p\u003e\u003cp\u003eIt is imperative to recognize that the absence of diagnostic and therapeutic measures for BT decrease is not substantiated by the condition's status as a modifiable, preventable, and treatable condition. The objective of this study was to ascertain the independent relationship between BT and mortality in patients with multiple trauma, while accounting for confounders. A secondary objective was to ascertain the validity of this association in patients experiencing cold stress.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eDesign and patient selection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA prospective cohort study was conducted at the Vall d\u0026apos;Hebron University Hospital Trauma Centre in Barcelona, Spain. A sample size calculation was performed a priori to ensure adequate statistical power. Based on published literature mortality rate [5,17] and our centre\u0026rsquo;s historical mortality rates, the study was powered to detect a mortality difference of 10% between hypothermic and normothermic patients with 80% power at a two-sided \u0026alpha; of 0.05, using a two-sample test for proportions. This yielded a target sample of approximately 300 patients. The study period enrolled all eligible polytrauma patients at Vall d\u0026rsquo;Hebron University Hospital Trauma Centre between 31 August 2022 and 28 February 2024 until the target sample size was reached. Vital signs were obtained within the first minutes of patient arrival, and the initial time of care served as confirmation. Out-of-hospital temperature measurement was conducted by means of an infrared thermometer of the Riester Ri-thermo\u0026reg; N tympanic thermometer (Riester GmbH \u0026amp; Co. KG, Jungingen, Germany). The measurement of in-hospital temperature was conducted in accordance with our established protocol for BT measurement. For patients without a protected airway, an axillary reading was obtained using a Filac ADA 3000 thermometer (Covidien, Cornell\u0026agrave; de Llobregat, Spain). In patients with a protected airway, the core temperature was measured using a bladder probe (Mon-a-ThermTM 400TM, Covidien, Degania, Israel) or an esophageal probe (Level 1TM Esophageal/Rectal Temperature Probe, ER400-12, 12FR, ICU Medical, Minneapolis, USA). This result was included in the initial vital signs record. The BT sample was categorized into the following groups: the temperature range is from \u0026lt;35\u0026deg;C, 35 to 35.9\u0026deg;C, 36 to 36.9\u0026deg;C, and from 37\u0026deg;C and above.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInclusion criteria\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria encompassed patients over the age of 18 years who met the criteria for activation of multiple trauma codes and were classified as SET 1 (immediate care) according to the Spanish Triage System (SET) [19].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData collection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData of multiple trauma patients was collected via the out- and in-hospital patient data management system (REDCap\u0026reg; system [20]) into a standardized protocol. The data were entered consecutively for each patient activation. Subsequently, these cases were reviewed by an independent reviewer who also conducted in-hospital follow-ups. A second reviewer conducted a follow-up period of a minimum of six months and verified the database prior to analysis.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStudy variables\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe following demographic data were collected out-of-hospital: age, sex, medical history, and American Society of Anesthesiologists (ASA) classification. Out-of-hospital data from Emergency Medical Services (EMS) were documented in accordance with the patient\u0026apos;s medical record and handover information, encompassing the season of the year, transport type, neurological status, temperature measurement, mechanism of injury, necessity for pharmaceutical interventions and airway management.\u003c/p\u003e\n\u003cp\u003eThe following data has been sourced from in-hospital records: Vital signs at hospital arrival, a neurological examination and initial resuscitation measures. Diagnostic tests (e.g. CT scan, laboratory results), initial measures to prevent hypothermia, Injury Severity Score (ISS), activation of the massive haemorrhage protocol and time of initial critical care. Survival and mortality with a minimum follow-up period of six months.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCategorical variables are described using absolute frequencies (n) and relative frequencies (%). Continuous variables with a normal distribution were described using the mean and standard deviation (SD), while those without a normal distribution were described using the median and interquartile range (IQR). The assessment of normality was conducted through the utilization of the Shapiro\u0026ndash;Wilk test and Q\u0026ndash;Q plots.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo estimate the association between BT and mortality, bivariate and multivariable logistic regression models were developed. Potential confounders, selected on the basis of biological plausibility and their impact on the odds ratio of BT (\u0026gt;15% variability), were included in the multivariable logistic regression models [21]. . To circumvent the issue of collinearity, the Variance Inflation Factor (VIF) was evaluated for each variable. The final model was selected based on the Akaike Information Criterion (AIC), with the lowest value indicating the best fit. The adequacy of the model was evaluated using goodness-of-fit tests, with the area under the curve (AUC) serving as a measure of predictive ability. The results were expressed as odds ratios (OR) and 95% confidence intervals (95% CI), with P \u0026lt; 0.05 indicating statistical significance. To analyse the relationship between BT and mortality among patients experiencing cold stress, a dichotomous variable was created based on a threshold of 36\u0026deg;C to assess the stability of this association. To address the potential heterogeneity in temperature measurement, a dichotomous variable distinguishing between core and peripheral readings was included in all multivariate models. The aim of this was to assess whether the type of measurement influenced the association of BT with mortality. All analyses were conducted using R (version 4.4.1; R Core Team, 2024).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthical considerations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the principles of the Declaration of Helsinki for research involving human participants and was approved by the Hospital Research Ethics Committee (CEIC) of the Hospital Universitario Vall d\u0026apos;Hebron. This study was approved by the CEIC (Protocol PR(AT)164/2022, initial approval date 03/05/2022). An amendment granting a waiver of informed consent for the emergency enrolment of multiple trauma patients was subsequently approved on 25/05/2023, based on the impracticability of obtaining individual consent after patient discharge. All patient data were coded for analysis, ensuring confidentiality, and all procedures complied local data protection regulations. The confidentiality and privacy of the data were guaranteed in accordance with the provisions of Spanish Organic Law 3/2018 of 5 December on Data Protection and Digital Rights Guarantees (LOPDPGDD). The present study is in accordance with the STROBE guidelines [22].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study comprised a total of 334 patients. Of these, 39 (11.7%) presented with hypothermia (BT\u0026lt; 35\u0026deg;C), and 251 (75.1%) with cold stress (BT 35-37\u0026ordm;C). Of the patients experiencing cold stress, 106 (42.2%) exhibited a BT ranging from 35 to 35.9\u0026deg;C, while 145 (57.8%) demonstrated a BT between 36 and 37\u0026deg;C (\u003cstrong\u003eTable 1\u003c/strong\u003e). The demographic profile of the patient population is characterized by a predominance of males, accounting for 80% of cases, with a mean age of 43.1 years. Out-of-hospital BT was measured in 28.5% of admitted patients, with a median value of 36\u0026deg;C (35-36\u0026deg;C). Regarding out-of-hospital interventions, 21.9% of patients required airway management, and epinephrine infusion was initiated in 11.7% of cases. An analysis of transport-related data revealed that 25.8% of patients were transferred by helicopter, 42.2% were admitted during the night, and 29.9% during the winter months. The most prevalent mechanisms of injury were falls (32.7%) and motorbike accidents (15.9%). In-hospital temperature was measured in 100% of patients, with a median temperature of 36.1\u0026deg;C (35.5\u0026ndash;36.5\u0026deg;C) (\u003cstrong\u003eTable 2\u003c/strong\u003e). Upon hospital arrival, 59.7% of the cohort presented with acidosis. Spinal injuries were the most prevalent diagnosis (40.6%). The utilization of rewarming air blankets was observed in 63.9% of the patients, while core temperature measurement was conducted in 28.6% of patients. The core temperature probe was inserted in 85% of patients with airway protection, in accordance with our established protocol.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMortality\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSix patients were excluded from the mortality analysis due to incomplete follow-up periods. The overall mortality rate was 10.4%. Patients with hypothermia exhibited a mortality rate of 25%, while those experiencing cold stress demonstrated a mortality rate of 12.3% when their BT ranged from 35\u0026deg;C to 35.9\u0026deg;C and 8.4% when their BT was between 36\u0026deg;C and 37\u0026deg;C. Univariate logistic regression analysis of BT and mortality demonstrated a statistically significant association (OR 0.51, 95% CI 0.3-0.7; P\u0026lt; 0.001) (\u003cstrong\u003eTable 3\u003c/strong\u003e). Following adjustment for ISS, ASA classification (I\u0026ndash;II vs. III\u0026ndash;IV), and out-of-hospital GCS \u0026lt;9 in a multivariate regression model, BT remained a significant independent predictor of mortality (OR 0.58, 95% CI: 0.37\u0026ndash;0.91; P=0.020). The marginal effects demonstrated an inverse relationship between BT and mortality (\u003cstrong\u003eFigure 1\u003c/strong\u003e). The present study found an association between an increase in BT from 35\u0026deg;C to 36\u0026deg;C and a 6.74% decrease in the probability of mortality. The probability of mortality decreased from 18.3% (95% CI: 10% \u0026ndash; 31%) to 11.6% (95% CI: 6.5% \u0026ndash; 19%). In a similar manner, an increase from 36\u0026deg;C to 37\u0026deg;C was associated with a 4.5% decrease in the probability of mortality, from 11.6% (95% CI: 6.5%-19.6%) to 7.1% (95% CI: 3.2% - 14%). The association between BT and mortality persisted even when the CT variable was considered (OR 0.56, 95% CI 0.35-0.89, P=0.015). In conclusion, the model under scrutiny exhibited good discriminative ability, as evidenced by an area under the curve (AUC) value of 0.923.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBody temperature sub-analysis at \u0026lt; 36\u0026ordm;C\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBT was dichotomized using a threshold of \u0026lt;36 \u0026deg;C to assess its association with mortality in a sensitivity analysis for patients experiencing cold stress. In univariable logistic regression, a temperature of \u0026lt;36 \u0026deg;C was found to be significantly associated with a crude OR of 2.65 (95% CI: 1.26\u0026ndash;5.57; P=0.01). The association remained robust after multivariable adjustment using the previously described logistic regression model (OR 3.29; 95% CI: 1.23\u0026ndash;8.77; P=0.017) (\u003cstrong\u003eTable 4\u003c/strong\u003e). For each ISS value, patients with a body temperature below 36\u0026deg;C consistently exhibit a higher probability of mortality compared to those with a temperature of 36\u0026deg;C or above (\u003cstrong\u003eFigure 2\u003c/strong\u003e). The observed association between BT and mortality remained consistent following the inclusion of a CT variable (OR 3.71; 95% CI: 1.34\u0026ndash;10.26; P=0.011). The discriminative ability of the model, utilizing the BT \u0026lt; 36\u0026ordm;C threshold, was 0.928 (AUC).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study demonstrates an independent association between a decrease in BT and increased mortality in multiple trauma patients. The inverse relationship between BT and mortality was evident across the entire cohort, with every 1\u0026deg;C decrease in BT resulting in a 72% increase in the odds of mortality. Whilst the present association is both consistent and clinically relevant, the observational design does not permit the establishment of a direct causal relationship.\u003c/p\u003e\u003cp\u003eThe present study's finding of a significant association between a BT\u0026thinsp;\u0026lt;\u0026thinsp;36\u0026deg;C and mortality in cold-stressed patients challenges the traditional view that only hypothermia is a concern. The findings of this study demonstrate that when two patients are compared suffering from cold-stress and multiple trauma, and the ISS, ASA classification, and out-of-hospital GCS\u0026thinsp;\u0026lt;\u0026thinsp;9 are found to be equal, the probability of death is threefold higher for the patient with a BT below 36\u0026deg;C. This finding serves to reinforce the notion that even a mild drop in temperature is not merely a marker of injury severity, but rather an independent risk factor for mortality [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The area under the curve (AUC) of this model using BT\u0026thinsp;\u0026lt;\u0026thinsp;36\u0026deg;C was 0.928, indicating an adequate adjustment for confounding factors and a high discriminatory capacity. If the model had been affected by significant residual confounding, its discriminatory power would have been reduced, resulting in a lower AUC. Should significant residual confounding have been present, it would have served to diminish the model's discriminative capacity. This would have resulted in a lower AUC.\u003c/p\u003e\u003cp\u003eThis finding is of particular interest in light of the recently updated ATLS 2025 version, which defines trauma hypothermia as a core temperature below 35\u0026ordm;C instead of 36\u0026ordm;C [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This stands in contrast to the European Trauma Course manual (2018 version), which advises maintaining a BT above 36\u0026ordm;C in traumatic shock patients [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. It is well-documented that patients with multiple traumas exhibit cardiovascular, neurological, respiratory and haematological dysfunctions, as well as increased mortality, when exposed to temperatures of 36\u0026deg;C or lower [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Lester et al. demonstrated that for each degree below 36\u0026deg;C, there was a 10% increase in packed red blood cell consumption within the initial 24 hours [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe prevalence of hypothermia (11.7%) and cold stress (75.1%) in our cohort, despite the generally warm climate in the Catalunya region, Spain, where the accidents occurred, highlights the need for proactive thermal monitoring and intervention. Our data challenge the common misconception that hypothermia is only a seasonal concern [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], as over half of our hypothermic patients (56.4%) arrived outside of the winter season. This is consistent with national data, which shows that 64.7% of fatal hypothermia accidents occurred outside of winter in Spain[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Since the clinical presentation of hypothermia can mimic other common trauma conditions, standardized protocols are crucial to prevent it from being missed at any point in the rescue chain.\u003c/p\u003e\u003cp\u003eIn our cohort, 100% of patients had their temperature measured in the emergency department, while the out-of-hospital measurement rate was 25%. Non-adherence to temperature recording is a global issue and is not specific to temperate climates [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In the German Trauma Registry DGU, 69% of records had missing temperature data [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The failure to measure temperature is associated with increased hospital mortality [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Furthermore, a significant shortcoming of scientific publications on hypothermia and trauma is the frequent omission of information on the method used to measure BT [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHypothermia is often overlooked in current training and education, and appropriate measurement and temperature management equipment may not be used in the out-of-hospital and in-hospital area, especially when the accident circumstances do not suggest the presence of cold stress or hypothermia. Our data support the implementation of BT measurement protocols and early rewarming strategies as a primary quality-of-care indicator in EMS and trauma centres. As a modifiable factor that directly influences survival, it is essential that we emphasize the importance of preventing BT decrease.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eOur study is single-centre. This limits the external validity of our findings. Due to the observational nature of the study, we cannot establish a direct causal relationship between hypothermia and mortality. Variability in the temperature measurement site, with 28.4% of initial measurements being core temperatures, may contribute to data heterogeneity. However, this measurement error is unlikely to obscure the overall trend. To address this potential bias, a dichotomous variable distinguishing between core and peripheral measurements was included in our regression model. This analysis demonstrated that, after adjusting for this variable, the BT remained a significant predictor of mortality. In our registry, there were limited numbers of patients with extreme temperature values, meaning that most of the study sample was concentrated within a relatively narrow temperature range (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, all measurements were taken within the first few minutes of hospital care by staff trained in hypothermia management. Our sample size is limited, which affects the adjustment of some covariables and their generalizability. We did not consider complications associated with a longer hospital stay, such as days of mechanical ventilation, infections, renal failure, or myopathy.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this study, a decrease in BT was found to be an independent and significant predictor of mortality in multiple trauma patients. For every 1\u0026ordm;C decrease in the BT, the odds of mortality increased by 72%. A BT threshold of \u0026lt;\u0026thinsp;36\u0026ordm;C was also identified as a significant predictor of mortality in cold-stressed patients. Cold-stressed patients with a BT\u0026thinsp;\u0026lt;\u0026thinsp;36\u0026deg;C had a threefold higher probability of death compared to those with the same ISS, ASA classification, and out-of-hospital GCS\u0026thinsp;\u0026lt;\u0026thinsp;9.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeepL software (DeepL SE, Cologne, Germany) for language editing of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRB:\u003c/strong\u003e Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Resources; Software; Supervision; Validation; Visualization; Writing \u0026ndash; original draft. \u003cstrong\u003eMA:\u003c/strong\u003e Validation; Visualization; Writing \u0026ndash; original draft. \u003cstrong\u003eIS:\u003c/strong\u003e Methodology; Supervision; Validation; Visualization; Writing \u0026ndash; original draft. \u003cstrong\u003eJM:\u003c/strong\u003e Data curation; Software; Validation; Writing \u0026ndash; review \u0026amp; editing. \u003cstrong\u003eNJ:\u003c/strong\u003e Validation; Writing \u0026ndash; review \u0026amp; editing. \u003cstrong\u003ePP:\u003c/strong\u003e Methodology; Supervision; Validation; Visualization; Writing \u0026ndash; review \u0026amp; editing. \u003cstrong\u003eAB:\u003c/strong\u003e Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Resources; Software; Supervision; Validation; Visualization; Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was granted by the Ethics Committee of the Vall d\u0026rsquo;Hebron University Hospital in Barcelona, Spain (reference number PR(AT)164/2022), and all study procedures were performed in accordance with the principles of the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEnrolment and data use followed a full waiver of informed consent approved by the CEIC (Protocol PR(AT)164/2022).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe adhere to ICMJE and COPE guidelines and have no conflicts of interest to disclose.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConflict of Interest/Funding Statement:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflicts of interest or sources of funding to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statement:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have the Clinical Research Ethics Committee authorization for this study and the entire sturdy conducted in accordance with the principles of the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOriginality Statement:\u0026nbsp;\u003c/strong\u003eThis work is original and has not been published in any other journal.\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eInjuries and violence [Internet]. [Cited on 6 October 2025.]. https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence. Access 6 oct 2025\u003c/li\u003e\n\u003cli\u003eLester E, Fox E, Holcomb J, Brasel K, Bulger E, Cohen M, et al. The impact of hypothermia on outcomes in massively transfused patients. J Trauma Acute Care Surg. 2019;86:458-63. https://doi.org/10.1097/TA.0000000000002144\u003c/li\u003e\n\u003cli\u003eWinkelmann M, Soechtig W, Macke C, Schroeter C, Clausen JD, Zeckey C, et al. Accidental hypothermia as an independent risk factor of poor neurological outcome in older multiply injured patients with severe traumatic brain injury: a matched pair analysis. Eur J Trauma Emerg Surg. 2019;45:255-61. https://doi.org/10.1007/s00068-017-0897-0\u003c/li\u003e\n\u003cli\u003eMartin RS, Kilgo PD, Miller PR, Hoth JJ, Meredith JW, Chang MC. INJURY-ASSOCIATED HYPOTHERMIA: AN ANALYSIS OF THE 2004 NATIONAL TRAUMA DATA BANK: Shock. 2005;24:114-8. https://doi.org/10.1097/01.shk.0000169726.25189.b1\u003c/li\u003e\n\u003cli\u003eAzarkane M, Rijnhout TWH, van Merwijk IAL, Tromp TN, Tan ECTH. Impact of accidental hypothermia in trauma patients: A retrospective cohort study. Injury. M. Azarkane, Department of Trauma Surgery, Geert Grooteplein Zuid 10, GA Nijmegen, Netherlands; 2024;55. https://doi.org/10.1016/j.injury.2023.110973\u003c/li\u003e\n\u003cli\u003eS\u0026oslash;reide K. Clinical and translational aspects of hypothermia in major trauma patients: From pathophysiology to prevention, prognosis and potential preservation. Injury. 2014;45:647-54. https://doi.org/10.1016/j.injury.2012.12.027\u003c/li\u003e\n\u003cli\u003eLott C, Truhl\u0026aacute;ř A, Alfonzo A, Barelli A, Gonz\u0026aacute;lez-Salvado V, Hinkelbein J, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021;161:152-219. https://doi.org/10.1016/j.resuscitation.2021.02.011\u003c/li\u003e\n\u003cli\u003eStrapazzon G, Procter E, Paal P, Brugger H. Pre-Hospital Core Temperature Measurement in Accidental and Therapeutic Hypothermia. High Alt Med Biol. Mary Ann Liebert, Inc., publishers; 2014;15:104-11. https://doi.org/10.1089/ham.2014.1008\u003c/li\u003e\n\u003cli\u003eAccidental hypothermia in adults: Clinical manifestations and evaluation. UpToDate. Updated Mar 14, 2025. [citado 10 de septiembre de 2025]; https://www.uptodate.com/contents/accidental-hypothermia-in-adults-clinical-manifestations-and-evaluation. Accedido 10 sep 2025\u003c/li\u003e\n\u003cli\u003eJurkovich GJ. Environmental Cold-Induced Injury. Surg Clin North Am. 2007;87:247-67. https://doi.org/10.1016/j.suc.2006.10.003\u003c/li\u003e\n\u003cli\u003ePerlman R, Callum J, Laflamme C, Tien H, Nascimento B, Beckett A, et al. A recommended early goal-directed management guideline for the prevention of hypothermia-related transfusion, morbidity, and mortality in severely injured trauma patients. Crit Care. 2016;20:107. https://doi.org/10.1186/s13054-016-1271-z\u003c/li\u003e\n\u003cli\u003eArthurs Z, Cuadrado D, Beekley A, Grathwohl K, Perkins J, Rush R, et al. The impact of hypothermia on trauma care at the 31st combat support hospital. Am J Surg. 2006;191:610-4. https://doi.org/10.1016/j.amjsurg.2006.02.010\u003c/li\u003e\n\u003cli\u003eJoint Trauma System. Hypothermia: Prevention and Treatment. CPG ID: 23. 07 Jun 2023. Accessed September 10, 2025. \u003c/li\u003e\n\u003cli\u003eMiranda D, Maine R, Cook M, Brakenridge S, Moldawer L, Arbabi S, et al. Chronic critical illness after hypothermia in trauma patients. Trauma Surg Acute Care Open. J. Cuschieri, Surgery at Zsfg, University of California San Francisco, San Francisco, CA, United States; 2021;6. https://doi.org/10.1136/tsaco-2021-000747\u003c/li\u003e\n\u003cli\u003eIreland S, Endacott R, Cameron P, Fitzgerald M, Paul E. The incidence and significance of accidental hypothermia in major trauma\u0026mdash;A prospective observational study. Resuscitation. 2011;82:300-6. https://doi.org/10.1016/j.resuscitation.2010.10.016\u003c/li\u003e\n\u003cli\u003eShafi S, Elliott AC, Gentilello L. 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. J Trauma Inj Infect Crit Care. S. Shafi, Department of Surgery, Division of Burn, Trauma and Surgical Critical Care, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9158, United States; 2005;59:1081-5. https://doi.org/10.1097/01.ta.0000188647.03665.fd\u003c/li\u003e\n\u003cli\u003eTrentzsch H, Huber-Wagner S, Hildebrand F, Kanz K-G, Faist E, Piltz S, et al. Hypothermia for prediction of death in severely injured blunt trauma patients. Shock. H. Trentzsch, Department of Surgery, Hospital of the University of Munich, Campus Gro\u0026szlig;hadern, Marchioninistr. 15, 81377 Munich, Germany; 2012;37:131-9. https://doi.org/10.1097/SHK.0b013e318245f6b2\u003c/li\u003e\n\u003cli\u003eWang HE, Callaway CW, Peitzman AB, Tisherman SA. Admission hypothermia and outcome after major trauma: Crit Care Med. 2005;33:1296-301. https://doi.org/10.1097/01.CCM.0000165965.31895.80\u003c/li\u003e\n\u003cli\u003eG\u0026oacute;mez Jim\u0026eacute;nez J, editor. Sistema Estructurado de Triaje - SET: Manual de implementaci\u0026oacute;n. Andorra: Esbarzer S.L. ,Treelogic S.L.; 2015. \u003c/li\u003e\n\u003cli\u003eHarris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O\u0026rsquo;Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208. https://doi.org/10.1016/j.jbi.2019.103208\u003c/li\u003e\n\u003cli\u003eHosmer DW, Lemeshow S, Sturdivant RX. Applied Logistic Regression. 3a edici\u0026oacute;n. Wiley; 2013. \u003c/li\u003e\n\u003cli\u003eElm E von, Altman DG, Egger M, Pocock SJ, G\u0026oslash;tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. The Lancet. Elsevier; 2007;370:1453-7. https://doi.org/10.1016/S0140-6736(07)61602-X\u003c/li\u003e\n\u003cli\u003eOkada A, Okada Y, Narumiya H, Ishii W, Kitamura T, Iiduka R. Body temperature and in-hospital mortality in trauma patients: analysis of a nationwide trauma database in Japan. Eur J TRAUMA Emerg Surg. 2022;48:163-71. https://doi.org/10.1007/s00068-020-01489-9\u003c/li\u003e\n\u003cli\u003eAmerican College of Surgeons Committee on Trauma. Advanced Trauma Life Support (ATLS): Student Course Manual. 11th ed. Chicago, IL: American College of Surgeons; 2025. \u003c/li\u003e\n\u003cli\u003eEuropean Trauma Course Manual. The team approach. 4th ed. European Trauma Course Organisation (ETCO) ivzw; 2018. p. 70. \u003c/li\u003e\n\u003cli\u003eWaibel BH, Schlitzkus LL, Newell MA, Durham CA, Sagraves SG, MF R. Impact of hypothermia (below 36 degrees C) in the rural trauma patient. J Am Coll Surg. United States: Department of Surgery, Division of Trauma and Surgical Critical Care, The Brody School of Medicine, East Carolina University, Greenville, NC, USA.; 2009;209:580-8. https://doi.org/10.1016/j.jamcollsurg.2009.07.021\u003c/li\u003e\n\u003cli\u003eEisenhauer I, April MD, Rizzo JA, Fisher AD, Maddry JK, Bebarta VS, et al. Seasonal Association With Hypothermia in Combat Trauma. Mil Med. 2023; https://doi.org/10.1093/milmed/usad451\u003c/li\u003e\n\u003cli\u003eBlasco Mari\u0026ntilde;o, Robert, Soteras Mart\u0026iacute;nez I. Manejo cl\u0026iacute;nico de la hipotermia accidental \u0026ndash; Revista Emergencias. 35:69-71. \u003c/li\u003e\n\u003cli\u003eBlasco Mari\u0026ntilde;o R, Argudo E, Soteras Martinez I. Antes y despu\u0026eacute;s de la primera reanimaci\u0026oacute;n cardiopulmonar extracorp\u0026oacute;rea por hipotermia accidental en Espa\u0026ntilde;a. Med Intensiva. Elsevier; 2024;48:551-4. https://doi.org/10.1016/j.medin.2024.05.021\u003c/li\u003e\n\u003cli\u003eAlam A, Olarte R, Nascimento B, Laflamme C, Tien H, Callum J. A retrospective quality audit regarding the incidence and treatment of hypothermia in severely injured trauma patients who undergo emergent surgery. CMAJ Can Med Assoc J. A. Alam, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 2016;59:S26. https://doi.org/10.1503/cjs.006816\u003c/li\u003e\n\u003cli\u003eRubiano AM, Sanchez AI, Estebanez G, Peitzman A, Sperry J, Puyana JC. The effect of admission spontaneous hypothermia on patients with severe traumatic brain injury. Injury. 2013;44:1219-25. https://doi.org/10.1016/j.injury.2012.11.026\u003c/li\u003e\n\u003cli\u003eWeuster M, Br\u0026uuml;ck A, Lippross S, Menzdorf L, Fitschen-Oestern S, Behrendt P, et al. Epidemiology of accidental hypothermia in polytrauma patients: An analysis of 15,230 patients of the TraumaRegister DGU. J Trauma Acute Care Surg. 2016;81:905-12. https://doi.org/10.1097/TA.0000000000001220\u003c/li\u003e\n\u003cli\u003eKlauke N, Gr\u0026auml;ff I, Fleischer A, Boehm O, Guttenthaler V, Baumgarten G, et al. Effects of prehospital hypothermia on transfusion requirements and outcomes: A retrospective observatory trial. BMJ Open [Internet]. M. Wittmann, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany; 2016;6. https://doi.org/10.1136/bmjopen-2015-009913\u003c/li\u003e\n\u003cli\u003eThompson HJ, Kirkness CJ, Mitchell PH. Hypothermia and Rapid Rewarming Is Associated With Worse Outcome Following Traumatic Brain Injury. J Trauma Nurs. 2010;17:173-7. https://doi.org/10.1097/JTN.0b013e3181ff272e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Out-of-hospital characteristics of multiple trauma patients stratified by admission body temperature. BT: body temperature. ASA: American Society of Anesthesiologists physical status classification. GCS: Glasgow Coma Scale. Data are presented as number (percentage) for categorical variables, mean (standard deviation, SD) for normally distributed continuous variables, and median (interquartile range, IQR) for non-normally distributed continuous. variables. Out-of-hospital BT refers to temperature recorded before hospital arrival.\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1762771314.png\" width=\"746\" height=\"764\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Clinical characteristics and in-hospital outcome of multiple trauma patients stratified by admission body temperature. BT: Body temperature. ASA: American Society of Anesthesiologists physical status classification. GCS: Glasgow Coma Scale. HR: heart rate. RR: respiratory rate. SBP: Systolic blood pressure. DBP: Diastolic blood pressure. ISS: Injury Severity Score, TBI: Traumatic brain injury. Data are presented as number (percentage) for categorical variables, mean (standard deviation) for normally distributed continuous variables, and median (interquartile range) for non-normally distributed continuous variables. *\u003cem\u003eAirway management for surgery during initial care was not included, only airway protection on admission due to severity or clinical evaluation.\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1762771353.png\" width=\"670\" height=\"823\"\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eUnivariate and multivariate logistic regression for assessing the association between mortality and BT AIC 132, Nagelkerke R2 0.532, AUC 0.923. Crude OR shows the association in the univariate analysis. Multivariate regression shows the OR of BT adjusted by ISS, ASA (I-II vs III-IV), CT (yes/no), and out-of-hospital GCS \u0026lt;9. OR = odds ratio; 95% CI = 95% confidence interval; P = P-value; ISS = Injury Severity Score; ASA = American Society of Anesthesiologists; GCS = Glasgow Coma Scale, BT = Body temperature, CT = Core temperature.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"574\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eBT at admission\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (CI 95%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eCrude OR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.51 (0.3 - 0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eAdjusted OR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.58 (0.37 \u0026ndash; 0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eAdjusted OR including CT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.56 (0.35 - 0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eUnivariate and multivariable logistic regression analysis of BT dichotomized at \u0026lt;36\u0026ordm;C and mortality. This table represents a sensitivity analysis for cold-stressed patients to assess the stability of the association between body temperature and mortality. Multivariate regression shows the OR of BT adjusted by ISS, ASA (I-II vs III-IV), CT (yes/no), and out-of-hospital GCS \u0026lt;9. AIC 131, Nagelkerke R2 0.536, AUC 0.928. OR = odds ratio; 95% CI = 95% confidence interval; P = P-value; ISS = Injury Severity Score; ASA = American Society of Anesthesiologists; GCS = Glasgow Coma Scale, BT = Body temperature, CT = Core temperature.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"574\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eBT at admission \u0026lt; 36\u0026ordm;C\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (CI 95%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eCrude OR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.65 (1.26 - 5.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eAdjusted OR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3.29 (1.23 \u0026ndash; 8.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eAdjusted OR including CT\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3.71 (1.34 - 10.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hypothermia, Multiple trauma, Advanced trauma life support care, Emergencies, Mortality","lastPublishedDoi":"10.21203/rs.3.rs-7837483/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7837483/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eTrauma is the leading cause of death among working-age people. Individuals who have experienced trauma are more susceptible to developing accidental hypothermia. This condition has been demonstrated to be associated with poor clinical outcomes. The primary objective of this study was to identify the association between body temperature (BT) and mortality in patients with multiple trauma. A secondary objective was to ascertain whether this association remained significant in patients experiencing cold stress.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA prospective cohort study was conducted in a level-3-trauma centre in Barcelona, Spain, between August 2022 and February 2024. Data pertaining to demographics, out-of-hospital and in-hospital clinical variables were collected. BT was categorised as follows: \u0026lt;35\u0026deg;C, 35-35.9\u0026deg;C, 36\u0026ndash;37\u0026deg;C, and \u0026gt;\u0026thinsp;37\u0026deg;C. Bivariate and multivariate logistic regression were conducted to assess the association between BT and mortality. A sensitivity analysis was also performed using a dichotomous BT threshold of \u0026lt;\u0026thinsp;36\u0026deg;C.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe study comprised 334 patients, with an overall mortality rate of 10.4%. Hypothermia (BT\u0026thinsp;\u0026lt;\u0026thinsp;35\u0026deg;C) was observed in 11.7% of patients, resulting in a mortality rate of 25%. Patients experiencing cold stress (35\u0026ndash;37\u0026deg;C) constituted 75.1% of the cohort. Bivariate logistic regression revealed a significant inverse relationship between BT and mortality (OR 0.51, 95%CI 0.3\u0026ndash;0.7; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Following multivariable adjustment, the association remained robust (OR 0.58, 95%CI 0.37\u0026ndash;0.91; P\u0026thinsp;=\u0026thinsp;0.02). A subsequent sensitivity analysis demonstrated that a BT\u0026thinsp;\u0026lt;\u0026thinsp;36\u0026deg;C was an independent predictor of mortality for patients experiencing cold stress (OR 3.29; 95%CI: 1.23\u0026ndash;8.77; P\u0026thinsp;=\u0026thinsp;0.017).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eBT was identified as an independent and significant predictor of mortality in patients with multiple trauma. For every 1\u0026deg;C decrease in BT, the odds of mortality increased by 72%. Patients who experienced cold stress with a BT\u0026thinsp;\u0026lt;\u0026thinsp;36\u0026deg;C exhibited a threefold elevated probability of mortality.\u003c/p\u003e\u003ch2\u003eClinical trial number:\u003c/h2\u003e\u003cp\u003enot applicable.\u003c/p\u003e","manuscriptTitle":"Body Temperature as a Predictor of Mortality in Multiple Trauma Patients: A Prospective Single-Centre Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-10 16:16:35","doi":"10.21203/rs.3.rs-7837483/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-17T07:53:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-08T13:25:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158574098756323610965713960352786023435","date":"2025-12-08T09:31:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-28T08:45:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136826211932387927780464668230211244279","date":"2025-11-28T08:02:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-29T09:24:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-29T09:13:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-23T16:03:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-17T21:06:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-10-17T21:02:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"21c3b2a9-93eb-48fb-91f5-30fd3f0a85fe","owner":[],"postedDate":"November 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":57652854,"name":"Health sciences/Diseases"},{"id":57652855,"name":"Health sciences/Health care"},{"id":57652856,"name":"Health sciences/Medical research"},{"id":57652857,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-01-26T16:10:18+00:00","versionOfRecord":{"articleIdentity":"rs-7837483","link":"https://doi.org/10.1038/s41598-026-35372-1","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-01-24 15:59:22","publishedOnDateReadable":"January 24th, 2026"},"versionCreatedAt":"2025-11-10 16:16:35","video":"","vorDoi":"10.1038/s41598-026-35372-1","vorDoiUrl":"https://doi.org/10.1038/s41598-026-35372-1","workflowStages":[]},"version":"v1","identity":"rs-7837483","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7837483","identity":"rs-7837483","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}