title: Predictive value of hyperthermia and intracranial hypertension on neurological outcomes in patients with severe traumatic brain injury.
abstract: BACKGROUND
  Intracranial hypertension (ICH) and hyperthermia are common after traumatic brain injury (TBI) and associated with worse neurological outcomes. This study sets out to determine the combined power of temperature and intracranial pressure (ICP) for predicting neurologic outcomes and prolonged length of stay (LOS) following severe TBI.
  
  
  METHODS
  High resolution (every 6 seconds) temperature and ICP data were collected in adults with severe TBI from 2008-2010. Temperatures were plotted against concurrent ICP and divided based on breakpoints (Temperature: <36, 36-38.5 or >38.5 °C, ICP: <20, 20-30 or >30 mmHg). The percentage of time spent in each section, as well as several pooled unfavourable conditions (hyperthermia ± ICH), were then evaluated for predictive value for ICU-LOS > 7 days and short-term (<6 months) vs. long-term (>6 months) dichotomized neurologic outcomes.
  
  
  RESULTS
  Fifty patients were included for analysis with severe TBI. Evaluation of the area under the operating receiver curve (AUC) showed significant periods of fever and high ICP (<30 mmHg) had a strong association with poor long-term neurological outcomes (Day 3, AUC = 0.71, p = 0.04) and were higher than either condition alone. ICU-LOS > 7 days was increased when hyperthermia and/or ICH remained uncontrolled by Day 5 (AUC = 0.82, p = 0.02).
  
  
  CONCLUSIONS
  Hyperthermia combined with ICH were shown to be significant prognostic indicators of future poor neurologic outcomes in patients with severe traumatic brain injury.
authors.affiliation: a Shock Trauma Anesthesia Research Organized Research Center, University of Maryland School of Medicine and R Adams Cowley Shock Trauma Center , Baltimore , MD , USA .
authors.forename: Brandon W
authors.initials: BW
authors.lastname: Bonds
authors.affiliation: a Shock Trauma Anesthesia Research Organized Research Center, University of Maryland School of Medicine and R Adams Cowley Shock Trauma Center , Baltimore , MD , USA .
authors.forename: Peter
authors.initials: P
authors.lastname: Hu
authors.affiliation: a Shock Trauma Anesthesia Research Organized Research Center, University of Maryland School of Medicine and R Adams Cowley Shock Trauma Center , Baltimore , MD , USA .
authors.forename: Yao
authors.initials: Y
authors.lastname: Li
authors.affiliation: a Shock Trauma Anesthesia Research Organized Research Center, University of Maryland School of Medicine and R Adams Cowley Shock Trauma Center , Baltimore , MD , USA .
authors.forename: Shiming
authors.initials: S
authors.lastname: Yang
authors.affiliation: a Shock Trauma Anesthesia Research Organized Research Center, University of Maryland School of Medicine and R Adams Cowley Shock Trauma Center , Baltimore , MD , USA .|b Duke University School of Medicine , Durham , NC , USA , and.
authors.forename: Katharine
authors.initials: K
authors.lastname: Colton
authors.affiliation: a Shock Trauma Anesthesia Research Organized Research Center, University of Maryland School of Medicine and R Adams Cowley Shock Trauma Center , Baltimore , MD , USA .
authors.forename: Anish
authors.initials: A
authors.lastname: Gonchigar
authors.affiliation: c Marshfield Clinic, Department of Surgery , Marshfield , WI , USA.
authors.forename: Jerry
authors.initials: J
authors.lastname: Cheriyan
authors.affiliation: a Shock Trauma Anesthesia Research Organized Research Center, University of Maryland School of Medicine and R Adams Cowley Shock Trauma Center , Baltimore , MD , USA .
authors.forename: Thomas
authors.initials: T
authors.lastname: Grissom
authors.affiliation: a Shock Trauma Anesthesia Research Organized Research Center, University of Maryland School of Medicine and R Adams Cowley Shock Trauma Center , Baltimore , MD , USA .
authors.forename: Raymond
authors.initials: R
authors.lastname: Fang
authors.affiliation: a Shock Trauma Anesthesia Research Organized Research Center, University of Maryland School of Medicine and R Adams Cowley Shock Trauma Center , Baltimore , MD , USA .
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Stein
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis / Q000503:physiopathology*; D003943:Diagnostic Techniques, Neurological; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000503:physiopathology*; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome
keywords: Hyperthermia; intracranial hypertension; traumatic brain injury