Research Article
Volume 12 Issue 12 - 2020
Abnormal Body Temperature in Patients with Severe Traumatic Brain Injury - A Predictor of Unfavourable Outcome
David Okon Udoh*, Oduwa Aghahowa and Mojisola O Udoh
Division of Neurological Surgery, Department of Surgery and Department of Morbid Anatomy, University of Benin and University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
*Corresponding Author: David Okon Udoh, Division of Neurological Surgery, Department of Surgery and Department of Morbid Anatomy, University of Benin and University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
Received: October 23, 2020; Published: November 28, 2020




Abstract

Background: Traumatic brain injury (TBI) is a global cause of disability and mortality. Clinical research on the epidemiological profile of TBI is suboptimal in low resource settings. Early identification of the predictors of outcome may be crucial in the triage and management of these patients. This study sought the predictors of outcome among demographic, clinical and computerized tomography (CT) scan variables in a tertiary centre in Nigeria.

Patients and Methods: The study population consisted 97 patients after the exclusion of 27 poly-traumatized patients from an initial 124 with severe TBI (post-resuscitation GCS of 3 - 8) admitted to neurosurgical care from June 2009 to May 2011 at our teaching hospital. Data were obtained from a computerized log of all TBI patients, case files and intensive care unit records, and analysed using STATA software version 12. 

Results: Age was not associated with the binary outcome of this study. Delay in arrival to the emergency room (ER) > 6 hours, lower GCS, systolic hypotension (< 90mmHg) and hypertension (> 140 mmHg), increasing respiratory rate (RR) > 30 cycles/min, non-reactive pupils, abnormal body temperature (< 36 and > 37.9 degree Celsius), endotracheal intubation (ETT) and mechanical ventilation were significantly associated with greater odds of an unfavourable outcome on univariate regression analysis. Abnormal body temperature was the most significant independent predictor of unfavourable outcome after multivariate regression analysis. The odds for unfavourable outcome in patients < 36.0 and > 37.9 degrees Celsius were 21.18 times (95% CI 3.45-130.09, p = 0.001) and 23.83 times (95%CI 5.47-103.86, p < 0.001), respectively, the odds in patients with normal body temperature respectively in a model of five covariates (See table 4). The presence of intracranial haematoma seemed associated with unfavourable outcome but did not attain statistical significance, while cerebral oedema (in the abscess of haematoma) was in the opposite direction predicting a favourable outcome after administration of intravenous mannitol as a standard protocol.

Conclusion: Abnormal body temperature could be a more sensitive pointer of an acute hypothalamic injury relative to abnormal pupillary reactivity. Hence, close body temperature monitoring could help early identification of the onset of secondary brain injury in rapidly deteriorating patients with severe TBI. This could facilitate early triage to ICU or neurosurgical intervention in low resource settings.

Keywords: Severe Traumatic Brain Injury (TBI); Predictors of Outcome; Abnormal Body Temperature; Most Significant Independent Predictor of Outcome; Acute Hypothalamic Injury

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Citation: David Okon Udoh., et al. “Abnormal Body Temperature in Patients with Severe Traumatic Brain Injury - A Predictor of Unfavourable Outcome”.EC Neurology 12.12 (2020): 73-82.

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