Accidental Hypothermia in Hospitalized Adults: Risk Factors, Management Strategies, and Clinical Outcomes: A Systematic Review.

Abstract

Accidental hypothermia (AH) in hospitalized adults is an under-recognized condition associated with increased morbidity, mortality, and prolonged hospital stays. Unlike primary AH caused by environmental exposure, inpatient hypothermia is often secondary to acute illness, comorbidities, iatrogenic factors, or medications that impair thermoregulation. We systematically reviewed studies reporting risk factors, management strategies, and clinical outcomes of AH in adults (≥18 years). Five studies, including 1,698 patients, met the inclusion criteria. Common risk factors were advanced age, male sex, alcohol use, reduced functional status, sepsis, endocrine or neurological disorders, and hospital-related exposures such as cool environments or unwarmed intravenous fluids. Management strategies comprised passive external, active external, and active internal rewarming, with ICU monitoring for moderate-to-severe cases. In-hospital mortality ranged from 13% to 26%, with complications including arrhythmias, coagulopathy, infection, and prolonged length of stay; trauma-specific populations had significantly higher mortality (OR ~5.18). These findings highlight the need for early recognition, targeted rewarming, and preventive measures in high-risk inpatients. Future multicenter prospective studies with standardized definitions and predictive models are required to optimize detection, management, and outcomes of AH in hospitalized adults.