Title : Prognostic role of fever in severe brain trauma
Abstract:
Introducton: Severe trauma'c brain injury (TBI) is defined as a high-risk global condi'on with a Glasgow Coma Scale score ≤ 8 that con'nues to challenge global public health, par'cularly among young adults. Despite the recent advances in the cri'cal care arena, mortality and morbidity are s'll elevated and mostly associated with secondary brain injury and infec'ous complica'ons acquired in the intensive care unit (ICU).
Methods: We carried out a retrospec've, descrip've, and analy'cal analysis over two years with 62 pa'ents hospitalized in the ICU for severe TBI. Epidemiological, clinical, paraclinical, infec'ous, and outcome data were collected and analyzed. Pa'ents were divided into two groups according to the dura'on of their febrile plateau (<48h vs. ≥48h).
Results: The mean age of pa'ents 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 a`er (16.1 percent). Mechanical ven'la'on was needed in all pa'ents (mean 13.8 days). Infec'ous complica'ons were common, with ven'lator-associated pneumonia (VAP) being the most frequent site. Both groups included predominance of gramnega've bacilli. Pa'ents with severe fever (≥48h) exhibited a greater spread of infec'on and greater mortality (52%), due predominantly to an acute neurologic decompensa'on (90%).
Conclusion: Young male pa'ents with severe TBI suffer from increased rates of infec'ous complica'ons, especially with VAP. Mortality is s'll strongly associated with secondary brain injury and nosocomial infec'ons. Op'mized prehospital care, enhanced infec'on preven'on, and prescrip'on of specific an'bio'cs are among the essen'al measures to improve the outcomes of such a vulnerable group.
