Burns. 2026 Jun 1;52(8):108098. doi: 10.1016/j.burns.2026.108098. Online ahead of print.
ABSTRACT
BACKGROUND: Hypothermia is common after major burn injury and may influence both systemic and wound-related outcomes. Although hypothermia has been associated with coagulopathy and higher rates of mortality in the trauma patient cohort, limited literature has examined its effects on the outcomes for patients with burns. The aim of this study was to identify the rate of hypothermia in patients transferred to a specialised burn unit, and to assess the impact on morbidity and mortality.
METHODS: This retrospective, single-centre study examined all burns presentations between 2009-2013. Hypothermia was defined as a core body temperature ≤ 35 °C on arrival. Statistical analysis used logistic regression for binary outcomes and negative binomial models for continuous outcomes. Multivariable logistic regression assessed hypothermia using continuous age, total body surface area burned (TBSA), and their interactions.
RESULTS: Of 268 patients with recorded temperature, 41 (15%) were hypothermic. Hypothermia increased with burn size (11.6% in <20% TBSA vs 35.7% in >50% TBSA; p < 0.01). Hypothermic patients had higher mean age (46.6 vs 41.0 years; p < 0.05) and larger burns (22.8% vs 14.7% TBSA; p < 0.01). Adequate first aid and use of the modified Parkland Formula were less frequently documented in hypothermic patients (75.7% vs 92.3% and 60.7% vs 79.5%, respectively; both p < 0.01). There was no significant difference in burn size across age groups (p = 0.918). On multivariable analysis, increasing TBSA was independently associated with hypothermia, whereas age was not, and no significant age-TBSA interaction was identified (p = 0.647). Hypothermia was associated with higher in-hospital mortality (14.6% vs 3.5%), longer ICU LOS (4.39 vs 2.33 days), and higher sepsis rates (9.8% vs 2.6%); but lower rates of skin grafting (36.6% vs 51.1%) and shorter hospital LOS (17.3 vs 19.7 days). On multivariable analysis, hypothermia independently predicted mortality, LOS, grafting, wound infection and sepsis.
CONCLUSIONS: Hypothermia remains common in burn patients transferred to a tertiary centre in NSW and is associated with larger burns, a higher average age, reduced adherence to early management protocols and poorer systemic outcomes despite reduced grafting rates and shorter hospital admissions.
PMID:42296598 | DOI:10.1016/j.burns.2026.108098
