Background: Hypothermia, coagulopathy and acidosis make up the fatal combination known as ‘the lethal triad of trauma’, which is associated with early mortality. Patients with major burns are at risk of this lethal triad and hypothermia is a readily modifiable factor during resuscitation of patients.
Objectives: To assess the incidence of the lethal triad and investigate temperature management practices of major burns patients during the 24-hour resuscitation period following arrival to an Adult Burns Service (ABS) hospital.
Methods: Eligible patients were adults (≥18 years of age) with burns ≥20% total body surface area admitted to an ABS hospital between January 1, 2022 and 31 July, 2023. Data were extracted from the Burns Registry of Australia and New Zealand and supplemented with a review of electronic medical records.
Results: There were 51 patients that met inclusion criteria. During the 24-hour period following arrival to the emergency department, the lethal triad was observed in 20% of patients, hypothermia was observed in 93%, coagulopathy in 23%, and acidosis in 55% of patients. Early temperature monitoring methods (0-6 hours) included bladder (40%), temporal (39%), nasoesophageal (10%), oral (5%), tympanic (5%) and axillary (1%) thermometry. A reduction in the proportion of patients with an hourly temperature recording was observed from 1 to 4 hours post admission in both individuals that survived (58% decrease) and died (45% decrease).
Conclusions: Hypothermia is commonly observed among patients with major burns and contributes to the lethal triad of death. Protocolised monitoring of temperature with warming strategies are indicated.