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Intern Med J. 2019 Apr 9. doi: 10.1111/imj.14308. [Epub ahead of print]

"Cold and lonely". Emergency presentations of patients with hypothermia to a large Australian health network.

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General Medical Unit, Alfred Health, Melbourne, Victoria, Australia.
Central and Eastern Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria.



Extreme heat is a public health priority in Australia with the health effects of cold poorly studied. A record-breaking cold winter prompted an institutional investigation into the epidemiology and outcomes of hypothermic presentations.


This was a retrospective cohort observational study of hypothermic emergency presentations between 7 July 2009 and 1 September 2016 with a temperature of ≤35°C. Independent predictors for inpatient mortality and characteristics of exposure versus non-exposure presentations were evaluated.


There were 217 patients with 226 presentations comprising male gender in 54%, median age 76.5 years (IQR 53-88) and median initial temperature 33.3°C (IQR 31.2-34.3°C). Non-exposure presentations being found indoors, accounted for 78% overall, with elderly persons ≥65 years (p=0.002) and multimorbidity (Charlson comorbidity index ≥4, p=0.013) overrepresented in this subgroup. Among the non-exposure cohort, 55% were pensioners and 42% lived alone. Inpatient mortality was 11% overall and significantly higher in non-exposure vs. exposure cohorts (16% vs. 2%, p=0.01). Independent predictors of inpatient mortality included heart failure (p=0.04), metastatic malignancy (p<0.01), chronic kidney disease (p<0.05) and sepsis (p<0.01). In contrast, exposure related presentations were characterised by younger patients with intoxication due to alcohol and/or illicit drugs and psychiatric co-morbidity.


Hypothermia is a marker of clinical and socioeconomic vulnerability. The dominant presentation of the elderly patient with multi-morbidity, and few social supports being found indoors, raises broader questions around the social determinants of health. This article is protected by copyright. All rights reserved.


Hypothermia; cold sepsis; congestive cardiac failure; elderly; sepsis; social isolation; temperature


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