Early postictal temperature changes in patients presenting to the emergency department.

Abstract

ObjectiveUnderstanding the elevations in body temperature after a seizure helps detect etiologies and monitor for complications. We aim to determine the proportion of patients who develop elevated temperatures after a seizure and to examine the trend in temperature change over time. We also seek to examine the effects that an infection or impaired ambulatory status might have on body temperature course, as well as the effect of elevated temperature on the length of hospital stay. MethodsA retrospective chart review was conducted at King Saud University Medical City. The included patients were individuals older than 12 years of age who presented to the emergency department with seizures between May 2015 and August 2018. Temperature recordings were documented from 18 four-hour time intervals (0–72 h from presentation). Information about age, gender, seizure duration, seizure type, polytherapy, anti-seizure medication, infection, ambulatory status, and length of stay were collected. Logistic regression and a mixed-effects model were used to determine which variables were associated with temperatures of 37.5 °C or higher in the first 12 h of presentation and to estimate the change in temperature over the ensuing time intervals. Results416 encounters were identified. The presence of an infection was significantly associated with developing temperature elevation, with an odds ratio (OR) of 2.8 (95% CI [1.54, 5.32]). Ambulatory patients were less likely to have elevations compared to non-ambulatory patients (OR = 0.33; 95% CI [0.18, 0.6]). Temperatures were highest within the first hours of presentation and gradually decreased with each interval by 0.03 °C (p < 0.0001), which increased to 0.12 °C (p = 0.005) if a patient was ambulatory. Temperatures substantially increased across the intervals in patients with infections by 0.21 °C (p < 0.0001). Elevated temperatures were significantly associated with longer hospital stays (p < 0.0001). ConclusionElevated temperatures can occur after seizures in general, and subside over the ensuing 72 h in the absence of an infection. Physicians should still conduct thorough evaluations in patients with temperatures of 37.5 °C or higher to rule out an underlying infection. The absence of an elevated temperature is favorable and associated with a shorter hospital stay.