Research Reports - A systematic review of the effects of body temperature on outcome after adult traumatic brain injury

J Neurosci Nurs. 2015 May 6

Madden LK(1), DeVon HA

OBJECTIVE: This systematic review describes effects of body temperature
alterations defined as fever, controlled normothermia, and spontaneous or induced
hypothermia on outcome after traumatic brain injury (TBI) in adults.
DATA SOURCES: A search was conducted using PubMed, Cochrane Library database,
Cumulative Index to Nursing and Allied Health Literature, EMBASE, and ISI Web of
Science in July 2013 with no back date restriction except for induced hypothermia
(2009).
STUDY SELECTION: Of 1366 titles identified, 712 were reviewed. Sixteen articles
met inclusion criteria: randomized controlled trials in hypothermia since 2009
(last Cochrane review) or cohort studies of temperature in TBI, measure core
and/or brain temperature, neurologic outcome reporting, primarily adult patients,
and English language publications. Exclusion criteria were as follows: most
patients with non-TBI diagnosis, primarily pediatric patients, case reports, or
laboratory/animal studies.
DATA SYNTHESIS: Most studies found that fever avoidance resulted in positive
outcomes including decreased length of stay in the intensive care unit;
mortality; and incidence of hypertension, elevated intracranial pressure, and
tachycardia. Hypothermia on admission correlated with poor outcomes. Controlled
normothermia improved surrogate outcomes. Prophylactic induced hypothermia is not
supported by the available evidence from randomized controlled trial.
CONCLUSION: Setting a goal of normothermia, avoiding fever, and aggressively
treating fever may be most important after TBI. Further research is needed to
characterize the magnitude and duration of temperature alteration after TBI,
determine if temperature alteration influences or predicts neurologic outcome,
determine if rate of temperature change influences or predicts neurologic
outcome, and compare controlled normothermia versus standard practice or
hypothermia.

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