Traumatic Brain Injury and Effects of Altitude - Human Performance ...

Traumatic Brain Injury (TBI) and Effects of Altitude:An Analysis of the LiteratureTable 7. Studies of temperature effects on TBIAuthor(s),Journal Title Population (N)Diringer et al.(2004) Crit CareMed, 32, 1489-1495Geffroy et al.(2004) IntensiveCare Med, 30,785-790Jiang et al.(2002)J Neurotrauma,19, 869-874Elevated bodytemperatureindependentlycontributes toincreased length ofstay in neurologicintensive care unitpatientsSevere traumatichead injury inadults:Which patients areat risk of earlyhyperthermia?Early indicators ofprognosis in 846cases of severetraumatic braininjuryCivilianN = 4295 neuro ptsIncludedN = 617 TBI ptsMean GCS = 9-13CivilianN = 101Severe TBIGCS < 8CivilianN = 864severe TBIGCS < 9Outcome x TBIseverityIllness severitysignificantlyassociatedw/fever andcomplicationsN/AN/AFindingsRetrospective review of largeneurological ICU cohort withmultiple diagnoses including tumor,stroke, subarachnoid hemorrhage,and TBI. Episode(s) of elevatedtemperature were associated withdose-dependent increase in ICU andhospital lengths of stay, worseoutcome, and increased mortalityrate for all diagnoses. Fever was thesecond most predictive factor, twiceas powerful a predictor of hospitallength of stay as severity of illness.Retrospective review found 44 of101 (44%) severe TBI patientsexperienced early hyperthermia,which was associated with 1) poorerrecovery and 2) moderate or severedisability. Strong risk factors forearly hyperthermia within 2 dayswere WBC count (> 14.5) onadmission and body temperature >36 C on admission. Prophylactic useof acetaminophen was negativelyassociated with early hyperthermia.Retrospective study of 864 severeTBI patients found hyperthermiaw/in 72 hrs post-injury to bestrongly correlated with morenegative patient outcome.September 14, 2010 42