Table 1.
Previous studies of body temperature and outcome after stroke - methods
| First author and year | Study design | N | Types of stroke | Temperature measurement method | Time of 1st; interval; last reading | Statistical analysis | Outcome measures | Definition of pyrexia |
|---|---|---|---|---|---|---|---|---|
|
Azzimondi 1995[2] |
P |
183 |
Any stroke <48 hrs (not SAH) |
A |
N/S; 12 h; 7 d |
Max temp in 7 d, logistic regression |
CNS, serial GCS up to 30 d, 1, 3 & 6 month Barthel |
≤37.2 = absence of fever. ≥37.9 = high fever |
|
Reith 1996[3] |
P |
390 |
Any stroke <6 hrs |
T |
<6 h; -; - |
Logistic regression |
Lesion size, SSS, presence of infection, WCC |
>37.5 |
|
Castillo 1998[9] |
P |
297 |
Ischaemic |
A |
<24 h; 2 h; 72 h |
Correlate peak temp with clinical outcome and final infarct vol. Stepwise logistic regression |
CSS, presence of infection, 4–7 d lesion volume, 3 month Barthel |
>37.5 |
|
Georgilis 1999[4] |
R |
330 |
Any stroke |
Most A, some RC |
<48 h; 3 h; - |
Presence/absence of fever and infection. Stepwise logistic regression |
GCS, SSS, CT lesion volume, presence of infection, use of invasive procedures |
>37.5 on >2 occasions on 2 consec. days |
|
Wang 2000[12] |
R |
437 |
Any “acute” stroke |
T |
“Admission” but no time limit given; -; - |
Logistic regression. ischaemic vs. haemorrhagic stroke |
Co-morbidities, WCC, [glucose], mortality (in-hospital and 1 yr) |
>37.5 |
|
Boysen 2001[8] |
P |
584 |
Ischaemic |
T |
<6 h; 2–4 h; 48 h |
Mean temp analysis by subgroup |
SSS, 3 month mRS |
>37.5 |
|
Kammersgaard 2002[6] |
P |
390 |
Any stroke |
T |
<6 h; -; - |
Dichotomised normothermia vs. pyrexia, and multivariate survival analysis |
SSS, [glucose], 5 yr mortality |
>37 |
|
Audebert 2004[13] |
R |
346 |
Ischaemic; Excl pts with infection pre- or post- stroke |
O or RC |
<24 h (mean 6.7 h); 2–12 h; 3 d |
Subgroup analysis of median temp days 1-3 |
NIHSS, WCC, CRP, 1–5 d lesion volume (CT/MR) |
≥37.5 |
|
Sulter 2004[1] |
P |
132 |
Ischaemic; Excl pts on antibiotics on admission |
RC |
<12 h; continuous; 48 h |
Dichotomised according to hyperthermia or not within 48 h |
baseline NIHSS, presence of infection, effect of antipyretics |
>37.5 |
|
Ernon 2006[14] |
R |
107 |
Ischaemic, with thrombo-lysis |
T/O |
<180 mins; random; 24 h; |
AUC relative to 37° and to baseline T° |
NIHSS, 3 month mRS |
>37.4 |
|
Leira 2006[11] |
P |
229 |
First ischaemic; Excl pts with inflammatory or infectious disease |
A |
<24 h; -; - |
Presence vs. absence baseline pyrexia |
CSS, BP, blood biochemistry, 4–7 d lesion volume (CT) |
≥37.5 |
|
Wong 2007[15] |
P |
156 |
Ischaemic |
T |
<48 h (median 2.5 h); 4 h; 48 h |
Mixed model, Lowess curves |
Baseline NIHSS, use of paracetamol, presence of infection |
None |
|
Idicula 2008[16] |
P |
127 |
Ischaemic with thrombo-lysis |
N/S |
<3 h; random; 5 d |
Pre-thombolysis temperature and peak temperature in 5 d |
NIHSS, 3 month mRS, BP, peak [glucose] |
>37.7 |
|
Millan 2008[17] |
R |
254 |
Ischaemic stroke with thrombolysis |
N/S |
<3 h; 6 h; 48 h |
Pre-thrombolysis, temperature at 24 and 48 h, and peak temperature within 24 h post- thrombolysis |
NIHSS, 3 month mRS, early lesion vol (CT), MCA TIBI score (TCD) |
≥37 |
|
Saini 2009[7] |
R |
5305 |
First ischaemic |
Most patients: A; others N/S |
N/S; 8 then 24 hrly; 7 d |
Normotherm vs. pyrexia at different time points |
WCC, NIHSS, 3 month mRS, lesion vol (1–7 d CT/MR), use of antibiotics |
>37.2 |
|
den Hertog (PAIS) 2009 & 2011[18,19] |
P RCT |
1399 or 1332 |
Any stroke <12 hrs |
T or RC |
median 6 h, all <12 h; -; - |
Multiple logistic regression |
baseline NIHSS, 14 d Barthel, 3 month mRS |
None |
|
Naess 2010[20] |
R |
250 (111 vs. 139) |
Ischaemic |
N/S |
< 6 h; -; - |
Logistic regression, temperature against outcome in tPA-treated vs. non-treated patients |
baseline NIHSS, mRS on day 7 or at discharge, vascular risk factors, stroke aetiology |
None |
| Phipps 2011[21] | R | 1361 | Ischaemic, NIHSS ≥ 2 | Majority – T, partially unknown | <48 h; -; - | Logistic regression | vascular risk factors, NIHSS, stroke aetiology | ≥37.8 |
P: prospective; SAH: subarachnoid haemorrhage; A: axillary; N/S: not specified; h: hours; d: days; CNS: Canadian Neurological Scale; GCS: Glasgow Coma Score; T: tympanic; SSS: Scandinavian Stroke Scale Score; WCC: white cell count; CSS: Canadian Stroke Scale; R: retrospective; RC: rectal; CT: computed tomography; mRS: modified Rankin Score; O: oral; NIHSS: National Institutes of Health Stroke Scale; CRP: C reactive protein; MR: magnetic resonance; AUC: area under the curve; BP: blood pressure; MCA: middle cerebral artery; TIBI: thrombolysis in brain ischaemia; TCD: transcranial Doppler; tPA: tissue plasminogen activator.