title: Severe traumatic head injury in adults: which patients are at risk of early hyperthermia?
abstract: OBJECTIVE
  Prevention of secondary insults, such as hyperthermia, is a major goal after traumatic brain injury. The aim of our study was to identify risk factors for early hyperthermia in severe head-injured patients.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A 17-bed multidisciplinary ICU of a 700-bed teaching hospital.
  
  
  METHODS
  A total of 101 adult patients admitted from January 1999 to December 2001 requiring continuous monitoring of intracranial pressure according to international guidelines.
  
  
  RESULTS
  Forty-four patients experienced early hyperthermia (at least one episode of body temperature >38.5 degrees C within the first 2 days). On univariate analysis five variables were associated with early hyperthermia: sex; body temperature; white blood cell count on admission; prophylactic use of acetaminophen; and diabetes insipidus within 2 days. On multivariate analysis, white blood cell count >14.5 x 10(9)/l on admission (odds ratio, 7.1; 95% confidence interval, 2.4-20.5; p=0.001) and a body temperature on admission >36 degrees C (odds ratio, 6.7; 95% confidence interval, 2.3-20.1) were strong risk factors of early hyperthermia. Prophylactic use of acetaminophen was negatively associated with early hyperthermia (odds ratio, 0.1; 95% confidence interval, 0.02-0.4). Patients who experienced early hyperthermia were less prone to have good recovery (GOS=5; p=0.03). More patients with severe or moderate disability (GOS=3 or 4) experienced early hyperthermia ( p=0.01).
  
  
  CONCLUSIONS
  We identified a subgroup of patients at high risk of early hyperthermia, which is common in severe head-injured patients. These results could have clinical implications for prevention of hyperthermia after traumatic brain injury in adults.
authors.affiliation: Department of Anesthesiology and Critical Care, Beaujon Hospital, Université Xavier Bichat Paris 7, Assistance Publique-Hôpitaux de Paris, 100 Bvd Général Leclerc, 92118 Clichy Cedex, France. arnaud.geffroy@bjn.ap-hop-paris.fr
authors.forename: Arnaud
authors.initials: A
authors.lastname: Geffroy
authors.forename: Régis
authors.initials: R
authors.lastname: Bronchard
authors.forename: Paul
authors.initials: P
authors.lastname: Merckx
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Seince
authors.forename: Thierry
authors.initials: T
authors.lastname: Faillot
authors.forename: Pierre
authors.initials: P
authors.lastname: Albaladejo
authors.forename: Jean
authors.initials: J
authors.lastname: Marty
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D001831:Body Temperature; D001930:Brain Injuries / Q000145:classification / Q000150:complications* / Q000401:mortality; D005260:Female; D005334:Fever / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015601:Injury Severity Score; D007427:Intracranial Pressure; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen