Mohamed Almuqamam, MD
PCCM Fellow
Saint Christopher's Hospital for Children
Philadelphia, Pennsylvania
Disclosure information not submitted.
Brian Novi, n/a
Pediatric Chief Resident
Saint Christoper's Hospital for Children, United States
Disclosure information not submitted.
Ajit Mammen, MD
Pediatric Critical Care Attending Physician
Saint Christoper's Hospital for Children, United States
Disclosure information not submitted.
Ryan DeSanti, DO
Saint Christopher's Hospital for Children
Philadelphia, Pennsylvania
Disclosure information not submitted.
Title: Therapeutic Intensity and Treatment of Hyperthermia in Severe Traumatic Brain Injury
Introduction: Severe acute traumatic brain injury (sTBI) is a leading cause of pediatric morbidity and mortality. There are no known effective primary therapies for sTBI and management thus centers on the prevention of secondary brain injury. Fever is both a well-established complication of sTBI and known to potentiate secondary injury. We aimed to describe the incidence, duration, severity, and management of fever in children with sTBI.
Methods: This is a retrospective observational study performed at a level one pediatric trauma center. We reviewed relevant data over the first 72 hours of PICU admission in all sTBI patients (presenting GCS ≤8). Collected data included demographic information, timing of the first temperature ≥38.0°C, total duration of temperature ≥38.0°C, maximum temperature, and the timing of all therapies aimed at either fever prevention or reduction. Data are presented using descriptive statistics.
Results: Thirty-five patients with sTBI were included (71% male; median age 4, IQR 0.88–11.0 years). The etiologies of TBI included motor vehicle accident (13/35, 37%), non-accidental head trauma (11/35, 31%), fall (6/35, 17%), and gunshot wounds (5/35, 14%). 62% of patients developed fever in the first 72 hours of hospitalization with a median time of 5.78 (IQR 3.19 – 13.09) hours to the first fever following PICU admission and a duration of the first fever of 120 (IQR 60 – 285) minutes. The median total duration of hyperthermia ≥38.0°C in the first 72 hours of PICU admission was 256 (IQR 76 – 495) minutes. Tylenol was prescribed to 66% of patients with a fever, a cooling blanket to 11%, and any other therapy aimed at temperature regulation to 3%. The median time from the first fever to the prescription of the first therapy aimed at prevention or management of hyperthermia was 1.22 (IQR -0.27 – 6.39) hours and was started after the first fever in 68% of patients.
Conclusions: Despite the well-described implications of fever in sTBI, it occurs with a high frequency in the clinical management of sTBI. Therapies aimed at prevention or treatment of fever commonly occurs after the start of the first fever and is a potentially modifiable risk factor for worse patient outcomes.