Abstract
Objectives: To determine the incidence of neurogenic fever (NF) in a population of patients in the acute phase following severe traumatic brain injury (TBI); to identify factors associated with the development of NF following severe TBI in adults.
Methods: Charts of patients admitted from 1996 to 1999 with severe TBI at a large, urban mid-Atlantic teaching hospital were retrospectively evaluated based on diagnostic criteria for each episode of hyperthermia to determine the diagnosis of NF. Data were collected regarding mechanism and area of injury, severity of injury, and demographic factors to determine potential predictors of NF.
Results: Diffuse axonal injury (DAI) (OR 9.06, 95% CI 0.99 to 82.7) and frontal lobe injury of any type (OR 6.68, 95% CI 1.1 to 39.3) are independently predictive of an increased risk of development of NF following severe TBI. The presence of a skull fracture and lower initial Glasgow Coma Score (GCS) were individual predictors of development of NF, but did not contribute to the final model.
Conclusions: These findings examine known and novel risk factors for this phenomenon in comparison to previously published literature on NF. A set of predictor variables was identified to help clinicians target patients at high risk for development of NF following severe TBI. It is hoped that earlier diagnosis and appropriate intervention for fever in the TBI patient will lead to improved outcomes.
Full Text
The Full Text of this article is available as a PDF (192.3 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Albrecht R. F., 2nd, Wass C. T., Lanier W. L. Occurrence of potentially detrimental temperature alterations in hospitalized patients at risk for brain injury. Mayo Clin Proc. 1998 Jul;73(7):629–635. doi: 10.1016/S0025-6196(11)64885-4. [DOI] [PubMed] [Google Scholar]
- Baker S. P., O'Neill B., Haddon W., Jr, Long W. B. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974 Mar;14(3):187–196. [PubMed] [Google Scholar]
- Benedek G., Tóth-Daru P., Janáky J., Hortobágyi A., Obál F., Jr, Colner-Sasi K. Indomethacin is effective against neurogenic hyperthermia following cranial trauma or brain surgery. Can J Neurol Sci. 1987 May;14(2):145–148. doi: 10.1017/s0317167100026275. [DOI] [PubMed] [Google Scholar]
- Britt R. H., Lyons B. E., Pounds D. W., Prionas S. D. Feasibility of ultrasound hyperthermia in the treatment of malignant brain tumors. Med Instrum. 1983 Mar-Apr;17(2):172–177. [PubMed] [Google Scholar]
- Chatzipanteli K., Alonso O. F., Kraydieh S., Dietrich W. D. Importance of posttraumatic hypothermia and hyperthermia on the inflammatory response after fluid percussion brain injury: biochemical and immunocytochemical studies. J Cereb Blood Flow Metab. 2000 Mar;20(3):531–542. doi: 10.1097/00004647-200003000-00012. [DOI] [PubMed] [Google Scholar]
- Childers M. K., Rupright J., Smith D. W. Post-traumatic hyperthermia in acute brain injury rehabilitation. Brain Inj. 1994 May-Jun;8(4):335–343. doi: 10.3109/02699059409150984. [DOI] [PubMed] [Google Scholar]
- Clinchot D. M., Otis S., Colachis S. C., 3rd Incidence of fever in the rehabilitation phase following brain injury. Am J Phys Med Rehabil. 1997 Jul-Aug;76(4):323–327. doi: 10.1097/00002060-199707000-00012. [DOI] [PubMed] [Google Scholar]
- Crompton M. R. Hypothalamic lesions following closed head injury. Brain. 1971;94(1):165–172. doi: 10.1093/brain/94.1.165. [DOI] [PubMed] [Google Scholar]
- Cunha B. A., Digamon-Beltran M., Gobbo P. N. Implications of fever in the critical care setting. Heart Lung. 1984 Sep;13(5):460–465. [PubMed] [Google Scholar]
- Cunha B. A., Tu R. P. Fever in the neurosurgical patient. Heart Lung. 1988 Nov;17(6 Pt 1):608–611. [PubMed] [Google Scholar]
- Dietrich W. D., Alonso O., Halley M., Busto R. Delayed posttraumatic brain hyperthermia worsens outcome after fluid percussion brain injury: a light and electron microscopic study in rats. Neurosurgery. 1996 Mar;38(3):533–541. doi: 10.1097/00006123-199603000-00023. [DOI] [PubMed] [Google Scholar]
- Dietrich W. D., Busto R., Valdes I., Loor Y. Effects of normothermic versus mild hyperthermic forebrain ischemia in rats. Stroke. 1990 Sep;21(9):1318–1325. doi: 10.1161/01.str.21.9.1318. [DOI] [PubMed] [Google Scholar]
- Dietrich W. D. The importance of brain temperature in cerebral injury. J Neurotrauma. 1992 May;9 (Suppl 2):S475–S485. [PubMed] [Google Scholar]
- Heindl U. T., Laub M. C. Outcome of persistent vegetative state following hypoxic or traumatic brain injury in children and adolescents. Neuropediatrics. 1996 Apr;27(2):94–100. doi: 10.1055/s-2007-973756. [DOI] [PubMed] [Google Scholar]
- Holtzclaw B. J. The febrile response in critical care: state of the science. Heart Lung. 1992 Sep-Oct;21(5):482–501. [PubMed] [Google Scholar]
- Kern K. B., Meislin H. W. Diabetes insipidus: occurrence after minor head trauma. J Trauma. 1984 Jan;24(1):69–72. [PubMed] [Google Scholar]
- Kilpatrick M. M., Lowry D. W., Firlik A. D., Yonas H., Marion D. W. Hyperthermia in the neurosurgical intensive care unit. Neurosurgery. 2000 Oct;47(4):850–856. doi: 10.1097/00006123-200010000-00011. [DOI] [PubMed] [Google Scholar]
- Kuroiwa T., Bonnekoh P., Hossmann K. A. Prevention of postischemic hyperthermia prevents ischemic injury of CA1 neurons in gerbils. J Cereb Blood Flow Metab. 1990 Jul;10(4):550–556. doi: 10.1038/jcbfm.1990.97. [DOI] [PubMed] [Google Scholar]
- Meythaler J. M., Peduzzi J. D., Eleftheriou E., Novack T. A. Current concepts: diffuse axonal injury-associated traumatic brain injury. Arch Phys Med Rehabil. 2001 Oct;82(10):1461–1471. doi: 10.1053/apmr.2001.25137. [DOI] [PubMed] [Google Scholar]
- Meythaler J. M., Stinson A. M., 3rd Fever of central origin in traumatic brain injury controlled with propranolol. Arch Phys Med Rehabil. 1994 Jul;75(7):816–818. [PubMed] [Google Scholar]
- Powers J. H., Scheld W. M. Fever in neurologic diseases. Infect Dis Clin North Am. 1996 Mar;10(1):45–66. doi: 10.1016/s0891-5520(05)70285-3. [DOI] [PubMed] [Google Scholar]
- Sazbon L., Groswasser Z. Outcome in 134 patients with prolonged posttraumatic unawareness. Part 1: Parameters determining late recovery of consciousness. J Neurosurg. 1990 Jan;72(1):75–80. doi: 10.3171/jns.1990.72.1.0075. [DOI] [PubMed] [Google Scholar]
- Segatore M. Fever after traumatic brain injury. J Neurosci Nurs. 1992 Apr;24(2):104–109. doi: 10.1097/01376517-199204000-00010. [DOI] [PubMed] [Google Scholar]
- Soukup Jens, Zauner Alois, Doppenberg Egon M. R., Menzel Matthias, Gilman Charlotte, Young Harold F., Bullock Ross. The importance of brain temperature in patients after severe head injury: relationship to intracranial pressure, cerebral perfusion pressure, cerebral blood flow, and outcome. J Neurotrauma. 2002 May;19(5):559–571. doi: 10.1089/089771502753754046. [DOI] [PubMed] [Google Scholar]
- Teasdale G., Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81–84. doi: 10.1016/s0140-6736(74)91639-0. [DOI] [PubMed] [Google Scholar]
- Whyte J., Filion D. T., Rose T. R. Defective thermoregulation after traumatic brain injury. A single subject evaluation. Am J Phys Med Rehabil. 1993 Oct;72(5):281–285. doi: 10.1097/00002060-199310000-00006. [DOI] [PubMed] [Google Scholar]