Abstract T P314: Higher Modified Graeb Scores May Predict Early Fever In Patients With Spontaneous Intracranial Hemorrhage

Abstract

Introduction: Both Intraventricular hemorrhage (IVH) and fever after spontaneous intracranial hemorrhage (ICH) have been consistently associated with poor outcomes. Additionally, IVH is an independent risk factor for fever after hemorrhagic stroke (ICH), but it is not known if the degree of intraventricular hemorrhage is predictive of fever. We hypothesized that the extent of intraventricular hemorrhage, defined by modified Graeb score, is associated with intensity of fever. Methods: We performed a single center, retrospective review of consecutively admitted adult patients with spontaneous ICH from April 2008 through June 2009. Patients were divided into two groups; those who registered a temperature of 38.5°C at least once during the first 48 hours of their hospitalization (“Early fever”) and those who did not (“No fever”). The degree of IVH was quantified by the Graeb score. Group comparisons were made using a student’s t-test for parametric data and a rank sum test for non-parametric data. Simple linear regression was performed to investigate the relationship between maximum temperature within the first 48 hours (Tmax) and Graeb score. Results: Of the 90 patients identified, 20% exhibited early fever. Age and intraparenchymal bleed volume were similar between groups. There was a trend toward more IVH in the febrile group (50% v. 30%, P=0.13), but this did not meet significance. Patients with early fever, however, had higher admission ICH scores (2 [0-2] vs. 1 [1-3], P = 0.01) and modified Graeb scores (1 [0-2] vs. 0 [0-13], P = 0.05). Patients with early fever had a worse GOSE at discharge than those without early fever (3[2-3] v. 3 [3-3], P=0.02). Amongst patients with IVH (n=28), the Graeb score was predictive of the Tmax (t=2.55. CI 0.01-0.08, P=0.02) Conclusion: Early fever in ICH is associated with worse outcomes at discharge. Increasing IVH, as reflected by increasing Graeb scores, is associated with higher temperatures in the first 48 hours of admission after ICH, suggesting early fever may be dose-dependent on the degree of IVH.