Fever in Trauma Patients: Evaluation of Risk Factors, Including Traumatic Brain Injury

Abstract

Background The role of fever in trauma patients remains unclear. Fever occurs as a response to release of cytokines and prostaglandins by white blood cells. Many factors, including trauma, can trigger release of these factors. Objectives To determine whether (1) fever in the first 48 hours is related to a favorable outcome in trauma patients and (2) fever is more common in patients with head trauma. Method Retrospective study of trauma patients admitted to the intensive care unit for at least 2 days. Data were analyzed by using multivariate analysis. Results Of 162 patients studied, 40% had fever during the first 48 hours. Febrile patients had higher mortality rates than did afebrile patients. When adjusted for severity of injuries, fever did not correlate with mortality. Neither the incidence of fever in the first 48 hours after admission to the intensive care unit nor the number of days febrile in the unit differed between patients with and patients without head trauma (traumatic brain injury). About 70% of febrile patients did not have a source found for their fever. Febrile patients without an identified source of infection had lower peak white blood cell counts, lower maximum body temperature, and higher minimum platelet counts than did febrile patients who had an infectious source identified. The most common infection was pneumonia. Conclusions No relationship was found between the presence of fever during the first 48 hours and mortality. Patients with traumatic brain injury did not have a higher incidence of fever than did patients without traumatic brain injury. About 30% of febrile patients had an identifiable source of infection. Further studies are needed to understand the origin and role of fever in trauma patients. (American Journal of Critical Care. 2015; 24:e1–e5)

Early fever after trauma: Does it matter?

“…Our estimate of the incidence of fever is in line with prior studies of early fever in neurologically injured patients, 6 and echoes a smaller study of fever in critically ill trauma patients where no difference in incidence of fever was observed between patients with TBI and without TBI. 5 That study by Bengualid et. al.…”

“…There is evidence to suggest that early fever is associated with higher injury severity scores (ISS) but not mortality in non-TBI trauma patients, leading the authors to impugn systemic inflammation as a possible cause of early fever. 5 In contrast, in TBI, it is assumed that early fever reflects injury to the brain structures responsible for homeostatic control of temperature, namely the anterior hypothalamus. We hypothesized that early fever is a direct result of brain injury, and thus would be more common in TBI than in major trauma without brain injury.…”

Fatores de risco para morte em pacientes com sepse em uma unidade de terapia intensiva

“…The invasion and proliferation of infectious agents in the abdominal cavity provoke an intense inflammatory process: release of cytokines; formation of free radicals and oxygen; reduction of cellular production of adenosine triphosphate, translocation of intestinal bacteria, and intestinal edema. These responses predispose the patients to multiple organ dysfunction syndrome, which leads to high rates of morbidity and mortality (17) .…”

Seven-point Checklist: Have You Prepared Sufficiently for the COVID-19 Crisis in Your Neurosurgery Department?

“…Furthermore, often infectious diseases coexist with trauma, but are occasionally masked and recognized as posttraumatic fever. 20 , 21) …”