PAPER

Neurogenic fever after traumatic brain injury: an epidemiological study

H J Thompson¹, J Pinto-Martin² and M R Bullock³

¹ School of Nursing, and Department of Neurosurgery, The University of Pennsylvania, Philadelphia, PA, USA
² School of Nursing, The University of Pennsylvania
³ Division of Neurosurgery, Virginia Commonwealth University Health System, VA, USA

Correspondence to:
Correspondence to:
H J Thompson, 105C Hayden Hall, 3320 Smith Walk, Dept of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA;
hilairet{at}nursing.upenn.edu

Objectives: To determine the incidence of neurogenic fever (NF) in a population of patients in the acute phase following severe traumatic brain injury (TBI); to identify factors associated with the development of NF following severe TBI in adults.

Methods: Charts of patients admitted from 1996 to 1999 with severe TBI at a large, urban mid-Atlantic teaching hospital were retrospectively evaluated based on diagnostic criteria for each episode of hyperthermia to determine the diagnosis of NF. Data were collected regarding mechanism and area of injury, severity of injury, and demographic factors to determine potential predictors of NF.

Results: Diffuse axonal injury (DAI) (OR 9.06, 95% CI 0.99 to 82.7) and frontal lobe injury of any type (OR 6.68, 95% CI 1.1 to 39.3) are independently predictive of an increased risk of development of NF following severe TBI. The presence of a skull fracture and lower initial Glasgow Coma Score (GCS) were individual predictors of development of NF, but did not contribute to the final model.

Conclusions: These findings examine known and novel risk factors for this phenomenon in comparison to previously published literature on NF. A set of predictor variables was identified to help clinicians target patients at high risk for development of NF following severe TBI. It is hoped that earlier diagnosis and appropriate intervention for fever in the TBI patient will lead to improved outcomes.

Keywords: head injury; post-traumatic hyperthermia; diffuse axonal injury

Abbreviations: CT, computed tomography; DAI, diffuse axonal injury; GCS, Glasgow Coma Score; HP, hypothalamic-pituitary; ISS, Injury Severity Score; MRI, magnetic resonance imaging; NF, neurogenic fever; TBI, traumatic brain injury

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