Risk factors for fever in the neurologic intensive care unit.
OBJECTIVE
To identify risk factors for fever among patients treated in a neurologic intensive care unit (NICU).


METHODS
The authors prospectively studied the frequency and causes of fever, defined as a patient's first temperature > or =101 degrees F (38.3 degrees C), among 387 patients consecutively admitted to their NICU. After identifying risk factors for 1) any fever, 2) infectious fever, and 3) unexplained fever using logistic regression, they calculated disease-specific adjusted odds ratios for developing these types of fever among 12 diagnostic groups.


RESULTS
Fever occurred in 23% (87/387) of patients. Fifty-two percent of fevers were explained by infection (predominantly pneumonia or bronchitis), and 28% were unexplained despite a complete diagnostic evaluation. NICU length of stay was a risk factor for all three types of fever (all p < 0.004); other risk factors included depressed level of consciousness for any fever (p = 0.005) and infectious fever (p = 0.048), endotracheal intubation for infectious fever (p = 0.01), and intraventricular catheterization for unexplained fever (p = 0.004). Subarachnoid hemorrhage increased the risk of both infectious and unexplained fever, even after adjusting for these risk factors (p = 0.006).


CONCLUSIONS
Fever occurs in nearly 25% of NICU patients, and is associated with increased length of stay and depressed level of consciousness. Endotracheal intubation is a risk factor for infectious fever, whereas intraventricular catheterization is a risk factor for unexplained fever, which suggests a role for ventricular hemorrhage in the pathogenesis of "central" fever. Subarachnoid hemorrhage increases the risk of developing fever of all types.
Commichau
Christopher
C
Division of Critical Care Neurology, Department of Neurology, Columbia University College of Physicians & Surgeons, New York, NY, USA.
Scarmeas
Nikolaos
N
Mayer
Stephan A
SA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000453:epidemiology*; D001991:Bronchitis / Q000453:epidemiology; D002557:Cerebrospinal Fluid Shunts / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D005334:Fever / Q000453:epidemiology*; D005335:Fever of Unknown Origin / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D009519:New York City / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology