Is body temperature an independent predictor of mortality in hip fracture patients? Murtuza Faizi a , Adam J. Farrier b , Murali Venkatesan c , Christopher Thomas d , Chika Edward Uzoigwe e, *, Siva Balasubramanian b , Robert P. Smith a a Leicester Royal Infirmary, Leicester, UK b University Hospitals of North Tees, Stockton-On-Tees, UK c Northampton General Hospital, Northampton, UK d University Hospitals of Coventry and Warwickshire, UK e Harcourt Building, 8 Harcourt Crescent, Sheffield, UK Introduction The risk stratification and prognostication of hip fracture patients is germane to safe clinical care. It is important for patient and family counselling, service provision, operative planning and treatment decisions [1,2]. Hu et al. performed a meta-analysis of studies examining prognosticators for hip fracture patients [3], with over 64,000 patients included. There was strong evidence for 12 predictors of mortality: advanced age, male gender, nursing home or facility residence, poor preoperative walking capacity, poor activities of daily living, higher American Society of Anesthesiologists (ASA) grading, poor mental state, multiple comorbidities, dementia or cognitive impairment, diabetes, cancer and cardiac disease. Maxwell et al. developed a scoring system to predict 30-day mortality for hip fracture patients [4]. They used multivariate regression analysis to distill the most potent predictors of mortality from the risk factors identified by previous researchers. They reported the seven most important predictors of Injury, Int. J. Care Injured 45 (2014) 1942–1945 A R T I C L E I N F O Article history: Accepted 27 September 2014 Keywords: Hip fracture Admission body temperature Hypothermia Pyrexia Mortality A B S T R A C T Introduction: Admission body temperature is a critical parameter in all trauma patients. Low admission temperature is strongly associated with adverse outcomes. We have previously shown, in a prospective study that low admission body temperature is common and associated with high mortality in hip fracture patients (Uzoigwe et al., 2014). However, no previous studies have evaluated whether admission temperature is an independent predictor of mortality in hip fracture patients after adjustment for the 7 recognised independent prognostic indicators (Maxwell et al., 2008). Methods: We retrospectively collated data on all patients presenting to our institution between June 2011 and February 2013 with a hip fracture. This included patients involved in the original prospective study (Uzoigwe et al., 2014). Admission tympanic temperature, measured on initial presentation at triage, was recorded. The prognosticators of age, gender, source of admission, abbreviated mental test score, haemoglobin, co-morbid disease and the presence or absence of malignancy were also recorded. Using multiple logistic regression, adjustment was made for these potentially confounding prognostic indicators of 30-day mortality, to determine if admission low body temperature were independently linked to mortality. Results: 1066 patients were included. 781 patients, involved in the original prospective study (Uzoigwe et al., 2014), presented in the relevant time frame and were included in the retrospective study. The mean age was 81. There were 273 (26%) men and 793 (74%) women. 407 (38%) had low body temperature (<36.5 8C). Adjustment was made for age, gender, source of admission, abbreviated mental test score, haemoglobin, co-morbid disease and the presence or absence of malignancy. Those with low body temperature had an adjusted odds ratio of 30-day mortality that was 2.1 times that of the euthermic (36.5–37.5 8C). Conclusions: Low body temperature is strongly and independently associated with 30-day mortality in hip fracture patients. ß 2014 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +44 07527907618; fax: +44 07527907618. E-mail address: chika@doctors.org.uk (C.E. Uzoigwe). Contents lists available at ScienceDirect Injury jo ur n al ho m epag e: ww w.els evier .c om /lo cat e/inju r y http://dx.doi.org/10.1016/j.injury.2014.09.024 0020–1383/ß 2014 Elsevier Ltd. All rights reserved.