Fever in trauma patients: evaluation of risk factors, including traumatic brain injury.
BACKGROUND
The role of fever in trauma patients remains unclear. Fever occurs as a response to release of cytokines and prostaglandins by white blood cells. Many factors, including trauma, can trigger release of these factors.


OBJECTIVE
To determine whether (1) fever in the first 48 hours is related to a favorable outcome in trauma patients and (2) fever is more common in patients with head trauma.


METHODS
Retrospective study of trauma patients admitted to the intensive care unit for at least 2 days. Data were analyzed by using multivariate analysis.


RESULTS
Of 162 patients studied, 40% had fever during the first 48 hours. Febrile patients had higher mortality rates than did afebrile patients. When adjusted for severity of injuries, fever did not correlate with mortality. Neither the incidence of fever in the first 48 hours after admission to the intensive care unit nor the number of days febrile in the unit differed between patients with and patients without head trauma (traumatic brain injury). About 70% of febrile patients did not have a source found for their fever. Febrile patients without an identified source of infection had lower peak white blood cell counts, lower maximum body temperature, and higher minimum platelet counts than did febrile patients who had an infectious source identified. The most common infection was pneumonia.


CONCLUSIONS
No relationship was found between the presence of fever during the first 48 hours and mortality. Patients with traumatic brain injury did not have a higher incidence of fever than did patients without traumatic brain injury. About 30% of febrile patients had an identifiable source of infection. Further studies are needed to understand the origin and role of fever in trauma patients.
Victoria Bengualid is the program director for internal medicine at St Barnabas Hospital, Bronx, New York. Goutham Talari is an internist at UK Healthcare, Lexington, Kentucky. David Rubin is director of pediatrics at St Barnabas Hospital. Aiham Albaeni is an assistant professor of medicine at Johns Hopkins Medicine, Baltimore, Maryland. Ronald L. Ciubotaru (deceased) was director of medicine at St Barnabas Hospital. Judith Berger is chief of the division of infectious diseases at St Barnabas Hospital. vbengualid@sbhny.org.
Victoria
V
Bengualid
Victoria Bengualid is the program director for internal medicine at St Barnabas Hospital, Bronx, New York. Goutham Talari is an internist at UK Healthcare, Lexington, Kentucky. David Rubin is director of pediatrics at St Barnabas Hospital. Aiham Albaeni is an assistant professor of medicine at Johns Hopkins Medicine, Baltimore, Maryland. Ronald L. Ciubotaru (deceased) was director of medicine at St Barnabas Hospital. Judith Berger is chief of the division of infectious diseases at St Barnabas Hospital.
Goutham
G
Talari
Victoria Bengualid is the program director for internal medicine at St Barnabas Hospital, Bronx, New York. Goutham Talari is an internist at UK Healthcare, Lexington, Kentucky. David Rubin is director of pediatrics at St Barnabas Hospital. Aiham Albaeni is an assistant professor of medicine at Johns Hopkins Medicine, Baltimore, Maryland. Ronald L. Ciubotaru (deceased) was director of medicine at St Barnabas Hospital. Judith Berger is chief of the division of infectious diseases at St Barnabas Hospital.
David
D
Rubin
Victoria Bengualid is the program director for internal medicine at St Barnabas Hospital, Bronx, New York. Goutham Talari is an internist at UK Healthcare, Lexington, Kentucky. David Rubin is director of pediatrics at St Barnabas Hospital. Aiham Albaeni is an assistant professor of medicine at Johns Hopkins Medicine, Baltimore, Maryland. Ronald L. Ciubotaru (deceased) was director of medicine at St Barnabas Hospital. Judith Berger is chief of the division of infectious diseases at St Barnabas Hospital.
Aiham
A
Albaeni
Victoria Bengualid is the program director for internal medicine at St Barnabas Hospital, Bronx, New York. Goutham Talari is an internist at UK Healthcare, Lexington, Kentucky. David Rubin is director of pediatrics at St Barnabas Hospital. Aiham Albaeni is an assistant professor of medicine at Johns Hopkins Medicine, Baltimore, Maryland. Ronald L. Ciubotaru (deceased) was director of medicine at St Barnabas Hospital. Judith Berger is chief of the division of infectious diseases at St Barnabas Hospital.
Ronald L
RL
Ciubotaru
Victoria Bengualid is the program director for internal medicine at St Barnabas Hospital, Bronx, New York. Goutham Talari is an internist at UK Healthcare, Lexington, Kentucky. David Rubin is director of pediatrics at St Barnabas Hospital. Aiham Albaeni is an assistant professor of medicine at Johns Hopkins Medicine, Baltimore, Maryland. Ronald L. Ciubotaru (deceased) was director of medicine at St Barnabas Hospital. Judith Berger is chief of the division of infectious diseases at St Barnabas Hospital.
Judith
J
Berger
D000328:Adult; D001831:Body Temperature; D001930:Brain Injuries / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007239:Infections / Q000150:complications / Q000503:physiopathology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000401:mortality*; D055815:Young Adult