Abstract 16144: Association Between Elevated Initial Trauma Center Body Temperature and Non-mortality Outcomes Following Major Traumatic Brain Injury

Abstract

Introduction: During prolonged hospitalization for Traumatic Brain Injury (TBI), fever has been identified as a possible cause of secondary brain injury and previous reports have identified an association between elevated body temperature and increased mortality following TBI. However, little is known about the relationship between an elevated initial trauma center body temperature (ITCT), measured immediately after EMS transport, and non-mortality outcomes. The purpose of this study was to determine if a correlation exists between elevated ITCT and various important patient outcomes. Methods: All moderate/severe TBI cases (CDC Barell Matrix Type 1) in the Arizona State Trauma Registry (ASTR; 1/1/07-12/31/12) were analyzed by the following ITCT categories: 36.5-37.9°C (normal-NT), 38.0-38.9°C (elevated-ET) and ≥39.0°C (very elevated-VET). Outcomes included: Trauma Center (TC) length-of-stay (LOS), Intensive Care Unit (ICU) LOS, and total TC charges. For continuous variables, non-parametric Kruskal-Wallis test was used to assess the median difference between the ET and VET cohorts and the NT group (reference). Wilcoxon two-sample tests identified groups with significant differences (alpha = 0.05). Results: 22,925 cases met inclusion criteria (exclusions: missing ITCT-2,885; missing demographics-700; ITCT <36.5°C - 8953). Both ET and VET had significantly longer TC LOS/ICU LOS and higher total hospital charges compared to the NBT group (all p values <0.0001; Figure 1). Conclusion: In this statewide study, ET or VET were associated with longer ICU LOS, longer hospital LOS and increased hospital charges. Future work is needed to identify the causes of temperature elevations that occur during prehospital TBI care (e.g., environmental factors versus autonomic dysregulation) and whether initiation of in-field measures to prevent temperature elevation might improve outcome.