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To the Editor: I have 2 concerns about the study by Dr Cooper and colleagues.¹

First, it is unclear whether the 2 groups were comparable in terms of their pattern of injury and severity. Some patients probably had major abdominal organ injuries; such patients were apparently hypotensive for an extended period of time. This could lead to a protracted period of splanchnic hypoperfusion, which is a potent trigger of posttraumatic cascade responses and, thus, a potential confounder.

Hypothermia presents a similar problem. Although both groups had mean core temperature at 35°C on hospital admission, the temperature distribution and the association between temperature characteristics and other main severity indices could affect later outcomes. Postinjury hypothermia in combination with acidosis and coagulation failure is a predictor of poor outcome.²

Second, I am concerned that the authors used univariate summary statistics. Given the large number of interdependent variables, a multivariate model would be . . . [Full Text of this Article]

Hans Husum, MD, PhD
Tromsoe Mine Victim Resource Center
University Hospital of Northern Norway
Tromsoe

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