title: The incidence of fever in US Critical Care Air Transport Team combat trauma patients evacuated from the theater between March 2009 and March 2010.
abstract: BACKGROUND
  Most critically ill injured patients are transported out of the theater by Critical Care Air Transport Teams (CCATTs). Fever after trauma is correlated with surgical complications and infection. The purposes of this study are to identify the incidence of elevated temperature in patients managed in the CCATT environment and to describe the complications reported and the treatments used in these patients.
  
  
  METHODS
  We performed a retrospective review of available records of trauma patients from the combat theater between March 1, 2009, and March 31, 2010, who were transported by the US Air Force CCATT and had an incidence of hyperthermia. We then divided the cohort into 2 groups, patients transported with an elevation in temperature greater than 100.4°F and patients with no documented elevation in temperature. We used a standardized, secure electronic data collection form to abstract the outcomes. Descriptive data collected included injury type, temperature, use of a mechanical ventilator, cooling treatment modalities, antipyretics, intravenous fluid administration, and use of blood products. We also evaluated the incidence of complications during the transport in patients who had a recorded elevation in temperature greater than 100.4°F.
  
  
  RESULTS
  A total of 248 trauma patients met the inclusion criteria, and 101 trauma patients (40%) had fever. The mean age was 28 years, and 98% of patients were men. The mechanism of injury was an explosion in 156 patients (63%), blunt injury in 11 (4%), and penetrating injury in 45 (18%), whereas other trauma-related injuries accounted for 36 patients (15%). Of the patients, 209 (84%) had battle-related injuries and 39 (16%) had non-battle-related injuries. Traumatic brain injury was found in 24 patients (24%) with an incidence of elevated temperature. The mean temperature was 101.6°F (range, 100.5°F-103.9°F). After evaluation of therapies and treatments, 80 trauma patients (51%) were intubated on a mechanical ventilator (P < .001). Of the trauma patients with documented fever, 22 (22%) received administration of blood products. Nineteen patients received antipyretics during their flight (19%), 9 received intravenous fluids (9%), and 2 received nonpharmacologic cooling interventions, such as cooling blankets or icepacks. We identified 1 trauma patient with neurologic changes (1%), 6 with hypotension (6%), 48 with tachycardia (48%), 33 with decreased urinary output (33%), and 1 with an episode of shivering or sweating (1%). We did not detect any transfusion reactions or deaths during flight.
  
  
  CONCLUSIONS
  Fever occurred in 41% of critically ill combat-injured patients evacuated out of the combat theater in Iraq and Afghanistan. Fewer than 20% of patients with a documented elevated temperature received treatments to reduce the temperature. Intubation of patients with ventilators in use during the transport was the only factor significantly associated with fever. Serious complications were rare, and there were no deaths during these transports.
authors.affiliation: Ft. Sam Houston, TX and Lackland AFB, TX; Tuscaloosa, AL; Atlanta, GA. Electronic address: jodymm13@yahoo.com.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Minnick
authors.forename: Vikhyat S
authors.initials: VS
authors.lastname: Bebarta
authors.forename: Marietta
authors.initials: M
authors.lastname: Stanton
authors.forename: Julio R
authors.initials: JR
authors.lastname: Lairet
authors.forename: James
authors.initials: J
authors.lastname: King
authors.forename: Pedro
authors.initials: P
authors.lastname: Torres
authors.forename: James
authors.initials: J
authors.lastname: Aden
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Ramirez
mesh_terms: D000293:Adolescent; D000328:Adult; D017732:Air Ambulances; D001930:Brain Injuries / Q000453:epidemiology / Q000451:nursing; D015897:Comorbidity; D003422:Critical Care / Q000379:methods*; D064648:Critical Care Nursing / Q000379:methods; D005260:Female; D005334:Fever / Q000453:epidemiology* / Q000451:nursing; D006801:Humans; D015994:Incidence; D007493:Iraq; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D010348:Patient Care Team; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000451:nursing; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000451:nursing; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000451:nursing; D055815:Young Adult
keywords: Combat; Critical care transport; Fever; Flight medicine; Military medicine; Trauma