• Rebecca L McCune, Brit J Long, Bradley A Dengler, Julie A Rizzo, Geoffrey W Peitz, Margaret A Moran, Michael D April, and Steven G Schauer.
• Department of Emergency Medicine, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, Texas 78234, USA. Electronic address: Rebecca.L.Mccune.mil@health.mil.
• World Neurosurg. 2025 Jan 29: 123736123736.

IntroductionEnvironmental hypothermia increases mortality in patients with major trauma, however the impact of exposure hypothermia on outcomes in isolated traumatic brain injury (TBI) is under-explored in literature. The aim of this study is to determine the relationship between environmental hypothermia and survival in patients with isolated blunt TBI.MethodsWe analyzed data from the Trauma Quality Improvement Program database. We included patients who were ≥15 years of age, had an abbreviated injury scale (AIS) ≥1 for the head/neck body region, an arrival Glasgow Coma Scale (GCS) of <14, an AIS of 0 for all other body regions, and a blunt mechanism. We defined hypothermia as <35 degrees Celsius.ResultsFrom 2020 to 2022, there were 16,697 patient encounters that met inclusion for this analysis. There were 670 (4%) patient encounters that met our definition of hypothermia. Hypothermic patients had lower unadjusted survival at 24 hours (79% versus 92%) and throughout their hospital stay (47% versus 77%, all p<0.001). In our multivariable logistic regression model, after adjusting for age, sex, arrival GCS, arrival shock index, mechanism of injury, and imaging findings, hypothermia was associated with lower survival at 24 hours (OR 0.59, 0.48-0.74) and lower total in-hospital survival (OR 0.44, 0.36-0.53).ConclusionsEnvironmental hypothermia is associated with increased mortality at 24 hours and at hospital discharge in patients with isolated blunt TBI. Further investigation is needed to identify optimal treatment strategies for TBI patients with hypothermia and to determine whether hypothermia prevention decreases mortality.Copyright © 2025. Published by Elsevier Inc.

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