Author(s): Gallagher M.J.; Papadopoulosa M.C.; Saadoun S.
Source: British Journal of Neurosurgery; 2018; vol. 32 (no. 1); p. 94
Publication Date: 2018
Publication Type(s): Conference Abstract
Abstract:Objectives: Traumatic spinal cord injury is a catastrophic event. Here, we investigated whether fever that occurs in the first few days after a spinal cord injury is detrimental. Design: Prospective observational study. Subjects: We recruited 44 patients aged 18-70 years, with acute, severe spinal cord injuries (American Spinal Injuries Association grades A-C). Methods: Temperature was measured from the axilla. We defined high fever >38degreeC. A pressure probe and a microdialysis catheter were placed on the spinal cord surface at the injury site. From the injury site, we monitored for up to a week. We also computed the fever burden for each patient, categorised into none, low, medium or high. Results: Our data indicate that fever occurs frequently after spinal cord injury (37% of the time). Compared with normothermia, high fever was associated with significantly more deranged injury site metabolism, lower glucose (median 1.7 vs 3.2 mM), higher lactate (7.2 vs 5.0 mM), higher glutamate (median 6.4 vs 5.7 mM) and higher lactate-to-pyruvate ratio (median 36.6 vs 28.6). The detrimental effect of high fever on metabolism was evident over a wide range of spinal cord perfusion pressures. Multivariate logistic regression analysis showed that the adverse effect of higher fever burden on neurological outcome was independent of ASIA grade on admission and patient age. Conclusions: We thus propose that fever in patients with acute traumatic spinal cord injury should be aggressively treated to improve neurological outcome.