Title : Prognostic role of fever in severe brain trauma
Abstract:
Introduction: Severe traumatic brain injury (TBI) is defined as a high-risk global condition with a Glasgow Coma Scale score ≤ 8 that continues to challenge global public health, particularly among young adults. Despite the recent advances in the critical care arena, mortality and morbidity are still elevated and mostly associated with secondary brain injury and infectious complications acquired in the intensive care unit (ICU).
Methods: We carried out a retrospective, descriptive, and analytical analysis over two years with 62 patients hospitalized in the ICU for severe TBI. Epidemiological, clinical, paraclinical, infectious, and outcome data were collected and analyzed. Patients were divided into two groups according to the duration of their febrile plateau (<48h vs. ≥48h).
Results: The mean age of patients was 33.7 years, with 73% under 40 years and a strong male predominance (87%). Road traffic accidents were the most common cause (83 percent), with assaults coming after (16.1 percent). Mechanical ventilation was needed in all patients (mean 13.8 days). Infectious complications were common, with ventilator-associated pneumonia (VAP) being the most frequent site. Both groups included predominance of gram- negative bacilli. Patients with severe fever (≥48h) exhibited a greater spread of infection and greater mortality (52%), due predominantly to an acute neurologic decompensation (90%).
Conclusion: Young male patients with severe TBI suffer from increased rates of infectious complications, especially with VAP. Mortality is still strongly associated with secondary brain injury and nosocomial infections. Optimized prehospital care, enhanced infection prevention, and prescription of specific antibiotics are among the essential measures to improve the outcomes of such a vulnerable group.
