Severe traumatic head injury in adults: Which patients are at risk of early hyperthermia?

• Published in: Intensive care medicine 2004-05, Vol.30 (5), p.785-790
• Main Authors: GEFFROY, Arnaud, BRONCHARD, Régis, MERCKX, Paul, SEINCE, Pierre-Francois, FAILLOT, Thierry, ALBALADEJO, Pierre, MARTY, Jean
• Format: Article
• Language: English
• Subjects: Acetaminophen - therapeutic use; Adult; Adults; Analgesics; Analgesics, Non-Narcotic - therapeutic use; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Blood; Body Temperature; Brain Injuries - classification; Brain Injuries - complications; Brain Injuries - mortality; Cohort analysis; Confidence intervals; Critical care; Diabetes; Female; Fever; Fever - etiology; Fever - prevention & control; Head injuries; Humans; Hyperthermia; Injury Severity Score; Intensive care; Intensive care medicine; Intracranial Pressure; Length of Stay; Leukocytes; Male; Medical sciences; Patients; Retrospective Studies; Risk Factors; Teaching hospitals; Trauma; Traumatic brain injury; Treatment Outcome
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-004-2280-y

Prevention of secondary insults, such as hyperthermia, is a major goal after traumatic brain injury. The aim of our study was to identify risk factors for early hyperthermia in severe head-injured patients. Retrospective cohort study. A 17-bed multidisciplinary ICU of a 700-bed teaching hospital. A total of 101 adult patients admitted from January 1999 to December 2001 requiring continuous monitoring of intracranial pressure according to international guidelines. Forty-four patients experienced early hyperthermia (at least one episode of body temperature >38.5 degrees C within the first 2 days). On univariate analysis five variables were associated with early hyperthermia: sex; body temperature; white blood cell count on admission; prophylactic use of acetaminophen; and diabetes insipidus within 2 days. On multivariate analysis, white blood cell count >14.5 x 10(9)/l on admission (odds ratio, 7.1; 95% confidence interval, 2.4-20.5; p=0.001) and a body temperature on admission >36 degrees C (odds ratio, 6.7; 95% confidence interval, 2.3-20.1) were strong risk factors of early hyperthermia. Prophylactic use of acetaminophen was negatively associated with early hyperthermia (odds ratio, 0.1; 95% confidence interval, 0.02-0.4). Patients who experienced early hyperthermia were less prone to have good recovery (GOS=5; p=0.03). More patients with severe or moderate disability (GOS=3 or 4) experienced early hyperthermia ( p=0.01). We identified a subgroup of patients at high risk of early hyperthermia, which is common in severe head-injured patients. These results could have clinical implications for prevention of hyperthermia after traumatic brain injury in adults.