Characteristics and outcomes of patients with cold-related local injuries and accidental hypothermia from emergency department-based surveillance network in northern region of South Korea

Abstract

Background: Cold weather has been known to cause various cold-related local injuries as well as accidental hypothermia. Objectives: The aim of this study is to investigate the basal characteristics, outcomes, and risk factors of patients with cold-related comorbidities using prospective emergency department-based surveillance system in high-risk area. Methods: We designed a prospective emergency department-based surveillance system throughout northern part of Gyeonggi province located in the northernmost of South Korea. A total of 20 emergency departments participated in the surveillance system. Patients who visited emergency department with cold-related comorbidities from 1 December 2012 to 28 February 2013 were prospectively enrolled in final analysis. We analyzed risk factors associated with outcome and correlation between climate factor (wind-chill index) and incidence. Results: During the study period, 54 patients with cold-related comorbidities were used for final analysis, including 35 hypothermia, 15 frostbite, and 4 trench foot. Among 35 patients with accidental hypothermia, 11 patients were admitted to intensive care unit and defined to have major adverse outcome. Hypothermic patient with major adverse outcome had lesser possession of coat as outwear when exposed to the cold (9.1% vs 58.3%, p < 0.01). Lower wind-chill index was likely to develop higher incidence of cold-related comorbidities (incidence rate ratio per 1°C decrease in wind-chill index: 1.086 (95% confidence interval: 1.038-1.135)). Conclusion: Patients with cold-related comorbidities were successfully monitored with emergency department-based surveillance system. Absence of coat was associated with major adverse outcomes in patient with accidental hypothermia. Lower wind-chill index was associated with higher incidence of cold-related comorbidities.