Neurosurgery Resident & Research Fellow Academic Neurosurgery Unit, St George's, University of London Surrey, United Kingdom
Introduction: Fever in the first week after acute traumatic spinal cord injury (TSCI) can be infective, inflammatory or neurogenic. We investigated the effect of different fever types (infective, inflammatory neurogenic) on the injured spinal cord in patients with acute, severe TSCI.
Methods: Longitudinal cohort study in a single neurosciences center. In 86 patients with TSCI, ASIA A-C who underwent surgery, we monitored intraspinal pressure (ISP), microdialysis (MD) and spinal cord tissue oxygen (psctO2) at the injury site for up to 7 days after surgery. We evaluated the effect of different fever types on the injury site by analyzing 2,864 hours of ISP, 1,887 hours of MD, and 840 hours of psctO2 data.
Results: High fever (> 38 C or 100.4 F) occurs in 76.7% of patients in the first week following TSCI and may be infective (49.9%), neurogenic (25.7%) or inflammatory (24.3%). Neurogenic fever only occurred with injuries cranial to T4. Compared with normothermia, fever was associated with reduced tissue glucose (all fevers), increased tissue lactate to pyruvate ratio (all fevers), reduced tissue oxygen (neurogenic + infective fevers) and elevated levels of pro-inflammatory cytokines/chemokines (infective fever). Cord metabolic derangement preceded the onset of infective but not neurogenic or inflammatory fever. By considering five clinical characteristics (level of injury, axillary temperature, leukocyte count, C-reactive protein, serum procalcitonin), it is possible to confidently distinguish neurogenic from non-neurogenic high fever in 59.3 % cases.
Conclusion : Our data suggests that neurogenic, infective, and inflammatory fevers commonly occur after acute spinal cord injury and are detrimental to the injured cord with infective fever the most injurious. Further studies are required to determine whether treating fever improves outcome.
How to Improve Patient Care: Prompt treatment of fever, ideally within 1 hour, may improve injury site metabolism and neurological outcome. Accurately diagnosing neurogenic fever may reduce unnecessary septic screens and overuse of antibiotics in these patients.
