Early Fever after Trauma: Does it Matter?.

Background: Fever is strongly associated with poor outcome after traumatic brain injury (TBI). We hypothesized that early fever is a direct result of brain injury and thus would be more common in TBI than in patients without brain injury, and associated with inflammation. Methods: We prospectively enrolled patients with major trauma with and without TBI from a busy level I trauma center ICU. Patients were assigned to one of four groups based on their presenting Head Abbreviated Injury Severity Scale scores (HAIS): Polytrauma: Head AIS score >2, one other region>2, Isolated Head: Head AIS score>2, all other regions 2, excluding Head/Face, Minor Injury: No region with AIS>2. Early fever was defined as at least one recorded temperature of >38.3[degrees]C in the first 48 hours after admission. Outcome measures included neurologic deterioration, length of stay in the ICU, hospital mortality, discharge Glasgow Outcome Scale-Extended (GOSE), and plasma levels of 7 key cytokines at admission and 24 hours (exploratory). Results: Two hundred and sixty-eight patients were enrolled; including subjects with Polytrauma (n=59), Isolated Head (n=97), Isolated Body (n=100) and Minor Trauma (n=12). The incidence of fever was similar in all groups irrespective of injury (11-24%). In all groups, there was a significant association between the presence of early fever and death in the hospital (6-18% v. 0-3%), as well as longer median ICU stays (3-7 days v. 2-3 days). Fever was significantly associated with elevated IL-6 at admission (50.7pg/dL v. 16.9pg/dL, P=0.0067) and at 24 hours (83.1pg/dL v. 17.1pg/dL, P=0.0025) in the isolated head injury group. Conclusion: Contrary to our hypothesis, early fever was not more common in patients with brain injury, though fever was associated with longer ICU stays and death in all groups. Additionally, fever was associated with elevated IL-6 levels in isolated head injury. Level of Evidence: III; Prognostic and Epidemiological study (C) 2017 Lippincott Williams & Wilkins, Inc.

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