Clinical outcome of traumatic brain injury patients with fever in a public hospital in Malaysia

Introduction: Fever has been known as one of the most common causes of traumatic brain injury (TBI) insults leading to mortality or morbidity. Monitoring and early detection of fever, as well as prevention of fever are said to be the keys to prevent or limit secondary injury in TBI, placing personnel within critical care facilities on the front line. The situation triggered the need for a study to identify the root causes of fever leading to mortality among TBI patients. Objectives: The present study was undertaken to investigate the occurrence of fever and its association with clinical outcomes among TBI patients. Materials and method: The study included 38 patients admitted and diagnosed of TBI for more than 48 hours at Hospital Tuanku Jaafar, Seremban (HTJS) from January to December 2016. Four-hourly patients’ body temperatures and fever interventions were recorded until a 7-day after critical-care admission or discharge, whichever occurred first. The outcomes of TBI patients with fever were measured using Glasgow Coma Scale (GCS) scores and survival status upon discharge from critical care facility. Results: Frequency of body temperatures of more than 37.4oC were recorded to be occurred in 32 among 38 patients within seven days of critical-care admission. Approximately 84.3% of these patients were admitted with severe GCS score (8-3), and discharged with mild GCS score (14-15) (43.8%). The fever interventions were started at body temperature of more than 38.2oC with n=22. Pharmacological administration was the most common intervention used (50.0%) followed by combination methods of pharmacological administration and physical cooling methods (31.8%); and application of physical cooling method only (9.1%). There was no significant association between fever occurrence and poor clinical outcome, χ2 (2, N=38) = 0.361, p>.05. Conclusion: There was no relationship between occurrences of fever during critical-care admissions and poor clinical outcomes. It reports an insight on the impact of fever among TBI patients and may contribute to health care providers with management and intervention strategies in reducing fever occurrences and thus improving patients’ outcomes.

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