Negative Effects of Aberrant Body Temperature After Traumatic Brain Injury
Background Over 1.7 million individuals sustain TBIs in the U.S. every year. Despite best-care practices based on published guidelines, many patients have poor outcomes. Prevention of secondary injury is one key strategy in which nurses can impact the severity of injury-related disability and death. Published guidelines provide limited evidence regarding prevention of secondary injury. Fever has been identified as a mechanism of secondary injury. Therefore, temperature management, a key responsibility of nurses, is one method to reduce this type injury. The optimal goal for body temperature following TBI has not yet been identified.
Methods Adult patients (> 16 years) that suffered moderate or severe blunt TBI (GCS < 13) over a four-year period (2008 – 2012) were included (n=340) in this single-site, secondary data analysis. Aberrant temperatures were identified as values outside of normal range (< 36.5°C [hypothermia] or > 37.5°C [fever]). Characteristics of temperature in the 96 hours after injury were evaluated. Regression analysis was used to assess relationships with 6-month survival, favorable outcome, and GOS-E.
Results Eighty-six percent of patients with any temperature < 36.5°C and 79% with any temperature > 37.5°C in the first 24 hours died. Fever during any of the time periods resulted in unfavorable outcome or death for 57.6%-73.6% of patients. Hypothermia (p=0.018) or fever in the first 24 hours (p=0.012) and fever 24-48-hours (p=0.006) after injury were significantly associated with GOS-E.
Implications Body temperature in the 96 hours after moderate to severe TBI significantly influences neurologic outcome. Controlled normothermia is one approach that may address these findings. Further research is necessary to assess these findings in a prospective, randomized multi-center clinical trial.