title: Environmentally responsive temperature instability in pediatric spinal cord injury.
abstract: OBJECTIVE
  To study the frequency and clinical implications of environmentally responsive temperature instability in hospitalized pediatric patients with spinal cord injury (SCI).
  
  
  METHODS
  A tertiary level SCI rehabilitation unit located in a free standing children's hospital in Wilmington, DE, USA.
  
  
  METHODS
  Temperature data and corresponding clinical responses were collected prospectively between January 1991 and June 1993. Fifty-four consecutive patients with SCI levels at or above T6 were admitted to the pediatric spinal cord injury rehabilitation unit over that time (4059 SCI days).
  
  
  METHODS
  Hypothermic events were defined as oral temperatures less than 35.0 degrees C or rectal temperatures less than 35.6 degrees C. Hyperthermic events were defined as oral temperatures greater than 38.0 degrees C or rectal temperatures greater than 38.4 degrees C. The events and the clinical responses were reviewed retrospectively and were used for subsequent analysis if there was evidence of clinical response to environmental manipulation within 4 hours of case identification, and other potential etiologies of temperature fluctuation could be excluded.
  
  
  RESULTS
  Sixty-five events of hypothermia (1.60%) and 14 events of hyperthermia (0.34%) were analyzed. Twelve patients (22%) accounted for all 79 events. Subjects with environmentally responsive temperature instability were more recently injured (P<0.001), had longer lengths of stay (P<0.001) and were more likely to be ventilator dependent (P<0.002) than those who did not have environmentally responsive temperature instability. There was no significant difference between the two groups in age, gender, level or etiology of the SCI. There were no adverse clinical outcomes as a result of the environmentally responsive temperature instability.
  
  
  CONCLUSIONS
  Environmentally responsive temperature instability affects a select subset of pediatric aged spinal cord injured persons. Early recognition of the potential contribution of the environment to temperature fluctuation in this group has led to the successful utilization of a temperature instability protocol on our SCI unit.
authors.affiliation: Division of Physical Medicine and Rehabilitation, The Glenrose Rehabilitation Hospital, The University of Alberta, Canada.
authors.forename: D E
authors.initials: DE
authors.lastname: McLean
authors.forename: J
authors.initials: J
authors.lastname: Kearney
authors.forename: M F
authors.initials: MF
authors.lastname: Cawley
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001833:Body Temperature Regulation / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D003080:Cold Temperature; D004780:Environment, Controlled; D005260:Female; D005334:Fever / Q000503:physiopathology; D006358:Hot Temperature; D006801:Humans; D007035:Hypothermia / Q000503:physiopathology; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D012737:Sex Factors; D013119:Spinal Cord Injuries / Q000503:physiopathology*; D016896:Treatment Outcome