Early fever in children with traumatic brain injury (TBI): Risk factors and relationship to mortality

Introduction: The occurrence of secondary insults during (he immediate post-injury period contributes to survival and functional outcome of patients with traumatic brain injury. Although hypotension and hypoxia have been found to be deleterious to the injured brain, other factors remain to be identified. In spite of the clinical impression that fever appears to be relatively common in the setting of TBI and animal models linking fever to adverse outcome for other neurologic insults, the impact of early fever in TBI has not been examined. The purpose of this investigation was to determine if early fever is associated with increased risk of mortality and, if so. to determine the incidence of and risk factors for such early fever in children. Methods: Medical records for 74 patients admitted to a pédiatrie intensive care unit (PICU) over an 18-month period were reviewed by PICU physicians. Mechanism and extent of injury including Glasgow Coma Scale (GCS), initial head computed tomography, and Pédiatrie Trauma Score (PTS) were determined upon admission. Early fever was defined as temperature38.5°C during the first 24 hours of admission to the PICU. Results: Patients ranged from 3 weeks to 15.2 years old with a mean age of 6.3±0.5 years, of whom 63.5% were boys. Upon presentation to the emergency department (ED) mean GCS was 10.0+0.6 and PTS was 7.2+0.4 with a median of 8. The overall mortality rate was 12.2% (n=9). The incidence of early fever was 24.3% (n=18), and mortality was 3.98 times more common among those with such fevers. Table: Number of children with early fever/number with risk factor GCS s 8 Edema ICH SAH CSF Risk factor present (%) 17/31(55) 6/9(67) 9/26(35) 7/19(37) 2/4(50) Risk factor absent (%) 1/43(2) 11/62(18) 8/45(18) 10/52(19) 16/70(23) p values < 0.0001 (0.005 0.15 0.21 0.25 ICH - mtracranial hemorrhage SAH - subarachnoid hemorrhage Conclusions: Early fever in children with TBI is associated with subsequent mortality. Risk factors for early fever following TBI have been identified and can provide an opportunity for application of fever-prevention protocols that may improve outcome. Further research regarding fever in the setting of TBI is warranted to determine its etiology, relationship to morbidity and mortality, and the benefits of preventive interventions.