Early hyperthermia after traumatic brain injury in children: Risk factors, influence on length of stay, and effect on short-term neurologic status

JoAnne E Natale, Jill G Joseph, Mark A. Helfaer, Donald H. Shaffner

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Objectives: a) To determine the risk factors for early hyperthermia after traumatic brain injury in children; b) to identify the contribution of early hyperthermia to neurologic status at pediatric intensive care unit (PICU) discharge and to PICU length of stay in head-injured children. Study Design: Observational cohort study. Setting: PICU at a tertiary care, university medical center. Patients: Children (n = 117) admitted to a PICU from July 1995 to May 1997 with traumatic brain injury. These children had a median age of 5.4 yrs (3 wks to 15.2 yrs old), and 33.4% were girls. Measurements and Main Results: Early hyperthermia (temperature >38.5°C within the first 24 hrs of admission) occurred in 29.9% of patients admitted to the PICU with traumatic brain injury. Risk factor predicting early hyperthermia included Glasgow Coma Scale score in the emergency department ≤8, pediatric trauma scorn ≤8, cerebral edema or diffuse axonal injury on initial head computed tomography scan, admission blood glucose >150 mg/dL (8.2 mmol/L), admission white cell count >14,300 cells/mm3 (14.3 x 103 cells/L), and systolic hypotension. The presence of early hyperthermia significantly increased the risk for Glasgow Coma Scale score <13 at PICU discharge (odds ratio [OR] 9.7, 95% confidence interval [CI] 2.8, 24.4) and PICU stay ≥3 days (OR 13.8, CI 5.1, 37.5). When we used multiple logistic regression models including injury severity and hypotension, early hyperthermia remained an independent predictor of lower Glasgow Coma Scale score at PICU discharge (OR 4.7, CI 1.4, 15.6) and longer PICU length of stay (OR 8.5, CI 2.8, 25.6). Conclusions: Early hyperthermia is independently associated with a measure of early neurologic status and resource utilization in children with traumatic brain injury serious enough to require PICU admission. These results support the prevention of hyperthermia in the management of traumatic brain injury in children. Further research is required to understand the mechanisms of this response and to identify appropriate preventive or therapeutic interventions.

Original languageEnglish (US)
Pages (from-to)2608-2615
Number of pages8
JournalCritical Care Medicine
Volume28
Issue number7
StatePublished - 2000
Externally publishedYes

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Pediatric Intensive Care Units
Nervous System
Length of Stay
Fever
Glasgow Coma Scale
Odds Ratio
Confidence Intervals
Hypotension
Logistic Models
Diffuse Axonal Injury
Head
Traumatic Brain Injury
Brain Edema
Wounds and Injuries
Tertiary Healthcare
Observational Studies
Blood Glucose
Hospital Emergency Service
Cohort Studies
Cell Count

Keywords

  • Glasgow Coma Scale
  • Hyperthermia
  • Length of stay
  • Multiple logistic regression
  • Pediatric intensive care
  • Resource utilization
  • Secondary brain injury
  • Traumatic brain injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Early hyperthermia after traumatic brain injury in children : Risk factors, influence on length of stay, and effect on short-term neurologic status. / Natale, JoAnne E; Joseph, Jill G; Helfaer, Mark A.; Shaffner, Donald H.

In: Critical Care Medicine, Vol. 28, No. 7, 2000, p. 2608-2615.

Research output: Contribution to journalArticle

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title = "Early hyperthermia after traumatic brain injury in children: Risk factors, influence on length of stay, and effect on short-term neurologic status",
abstract = "Objectives: a) To determine the risk factors for early hyperthermia after traumatic brain injury in children; b) to identify the contribution of early hyperthermia to neurologic status at pediatric intensive care unit (PICU) discharge and to PICU length of stay in head-injured children. Study Design: Observational cohort study. Setting: PICU at a tertiary care, university medical center. Patients: Children (n = 117) admitted to a PICU from July 1995 to May 1997 with traumatic brain injury. These children had a median age of 5.4 yrs (3 wks to 15.2 yrs old), and 33.4{\%} were girls. Measurements and Main Results: Early hyperthermia (temperature >38.5°C within the first 24 hrs of admission) occurred in 29.9{\%} of patients admitted to the PICU with traumatic brain injury. Risk factor predicting early hyperthermia included Glasgow Coma Scale score in the emergency department ≤8, pediatric trauma scorn ≤8, cerebral edema or diffuse axonal injury on initial head computed tomography scan, admission blood glucose >150 mg/dL (8.2 mmol/L), admission white cell count >14,300 cells/mm3 (14.3 x 103 cells/L), and systolic hypotension. The presence of early hyperthermia significantly increased the risk for Glasgow Coma Scale score <13 at PICU discharge (odds ratio [OR] 9.7, 95{\%} confidence interval [CI] 2.8, 24.4) and PICU stay ≥3 days (OR 13.8, CI 5.1, 37.5). When we used multiple logistic regression models including injury severity and hypotension, early hyperthermia remained an independent predictor of lower Glasgow Coma Scale score at PICU discharge (OR 4.7, CI 1.4, 15.6) and longer PICU length of stay (OR 8.5, CI 2.8, 25.6). Conclusions: Early hyperthermia is independently associated with a measure of early neurologic status and resource utilization in children with traumatic brain injury serious enough to require PICU admission. These results support the prevention of hyperthermia in the management of traumatic brain injury in children. Further research is required to understand the mechanisms of this response and to identify appropriate preventive or therapeutic interventions.",
keywords = "Glasgow Coma Scale, Hyperthermia, Length of stay, Multiple logistic regression, Pediatric intensive care, Resource utilization, Secondary brain injury, Traumatic brain injury",
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T1 - Early hyperthermia after traumatic brain injury in children

T2 - Risk factors, influence on length of stay, and effect on short-term neurologic status

AU - Natale, JoAnne E

AU - Joseph, Jill G

AU - Helfaer, Mark A.

AU - Shaffner, Donald H.

PY - 2000

Y1 - 2000

N2 - Objectives: a) To determine the risk factors for early hyperthermia after traumatic brain injury in children; b) to identify the contribution of early hyperthermia to neurologic status at pediatric intensive care unit (PICU) discharge and to PICU length of stay in head-injured children. Study Design: Observational cohort study. Setting: PICU at a tertiary care, university medical center. Patients: Children (n = 117) admitted to a PICU from July 1995 to May 1997 with traumatic brain injury. These children had a median age of 5.4 yrs (3 wks to 15.2 yrs old), and 33.4% were girls. Measurements and Main Results: Early hyperthermia (temperature >38.5°C within the first 24 hrs of admission) occurred in 29.9% of patients admitted to the PICU with traumatic brain injury. Risk factor predicting early hyperthermia included Glasgow Coma Scale score in the emergency department ≤8, pediatric trauma scorn ≤8, cerebral edema or diffuse axonal injury on initial head computed tomography scan, admission blood glucose >150 mg/dL (8.2 mmol/L), admission white cell count >14,300 cells/mm3 (14.3 x 103 cells/L), and systolic hypotension. The presence of early hyperthermia significantly increased the risk for Glasgow Coma Scale score <13 at PICU discharge (odds ratio [OR] 9.7, 95% confidence interval [CI] 2.8, 24.4) and PICU stay ≥3 days (OR 13.8, CI 5.1, 37.5). When we used multiple logistic regression models including injury severity and hypotension, early hyperthermia remained an independent predictor of lower Glasgow Coma Scale score at PICU discharge (OR 4.7, CI 1.4, 15.6) and longer PICU length of stay (OR 8.5, CI 2.8, 25.6). Conclusions: Early hyperthermia is independently associated with a measure of early neurologic status and resource utilization in children with traumatic brain injury serious enough to require PICU admission. These results support the prevention of hyperthermia in the management of traumatic brain injury in children. Further research is required to understand the mechanisms of this response and to identify appropriate preventive or therapeutic interventions.

AB - Objectives: a) To determine the risk factors for early hyperthermia after traumatic brain injury in children; b) to identify the contribution of early hyperthermia to neurologic status at pediatric intensive care unit (PICU) discharge and to PICU length of stay in head-injured children. Study Design: Observational cohort study. Setting: PICU at a tertiary care, university medical center. Patients: Children (n = 117) admitted to a PICU from July 1995 to May 1997 with traumatic brain injury. These children had a median age of 5.4 yrs (3 wks to 15.2 yrs old), and 33.4% were girls. Measurements and Main Results: Early hyperthermia (temperature >38.5°C within the first 24 hrs of admission) occurred in 29.9% of patients admitted to the PICU with traumatic brain injury. Risk factor predicting early hyperthermia included Glasgow Coma Scale score in the emergency department ≤8, pediatric trauma scorn ≤8, cerebral edema or diffuse axonal injury on initial head computed tomography scan, admission blood glucose >150 mg/dL (8.2 mmol/L), admission white cell count >14,300 cells/mm3 (14.3 x 103 cells/L), and systolic hypotension. The presence of early hyperthermia significantly increased the risk for Glasgow Coma Scale score <13 at PICU discharge (odds ratio [OR] 9.7, 95% confidence interval [CI] 2.8, 24.4) and PICU stay ≥3 days (OR 13.8, CI 5.1, 37.5). When we used multiple logistic regression models including injury severity and hypotension, early hyperthermia remained an independent predictor of lower Glasgow Coma Scale score at PICU discharge (OR 4.7, CI 1.4, 15.6) and longer PICU length of stay (OR 8.5, CI 2.8, 25.6). Conclusions: Early hyperthermia is independently associated with a measure of early neurologic status and resource utilization in children with traumatic brain injury serious enough to require PICU admission. These results support the prevention of hyperthermia in the management of traumatic brain injury in children. Further research is required to understand the mechanisms of this response and to identify appropriate preventive or therapeutic interventions.

KW - Glasgow Coma Scale

KW - Hyperthermia

KW - Length of stay

KW - Multiple logistic regression

KW - Pediatric intensive care

KW - Resource utilization

KW - Secondary brain injury

KW - Traumatic brain injury

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