Research Reports - Predictive value of hyperthermia and intracranial hypertension on neurological outcomes in patients with severe traumatic brain injury

Brain Inj. 2015 Oct 19:1-6. [Epub ahead of print]

Bonds BW(1), Hu P(1), Li Y(1), Yang S(1), Colton K(1,)(2), Gonchigar A(1),
Cheriyan J(3), Grissom T(1), Fang R(1), Stein DM(1).

BACKGROUND: Intracranial hypertension (ICH) and hyperthermia are common after
traumatic brain injury (TBI) and associated with worse neurological outcomes.
This study sets out to determine the combined power of temperature and
intracranial pressure (ICP) for predicting neurologic outcomes and prolonged
length of stay (LOS) following severe TBI.
METHODS: High resolution (every 6 seconds) temperature and ICP data were
collected in adults with severe TBI from 2008-2010. Temperatures were plotted
against concurrent ICP and divided based on breakpoints (Temperature: <36,
36-38.5 or >38.5 °C, ICP: <20, 20-30 or >30 mmHg). The percentage of time spent
in each section, as well as several pooled unfavourable conditions
(hyperthermia ± ICH), were then evaluated for predictive value for ICU-LOS > 7
days and short-term (<6 months) vs. long-term (>6 months) dichotomized neurologic
outcomes.
RESULTS: Fifty patients were included for analysis with severe TBI. Evaluation of
the area under the operating receiver curve (AUC) showed significant periods of
fever and high ICP (<30 mmHg) had a strong association with poor long-term
neurological outcomes (Day 3, AUC = 0.71, p = 0.04) and were higher than either
condition alone. ICU-LOS > 7 days was increased when hyperthermia and/or ICH
remained uncontrolled by Day 5 (AUC = 0.82, p = 0.02).
SUMMARY: Hyperthermia combined with ICH were shown to be significant prognostic
indicators of future poor neurologic outcomes in patients with severe traumatic
brain injury.

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