PREDICTIVE VALUE OF HYPERTHERMIA ON NEUROLOGICAL OUTCOMES IN SEVERE TRAUMATIC BRAIN INJURY

Abstract

Background: Hyperthermia is a frequently observed physiological disturbance after traumatic brain injury (TBI) and has been linked to secondary brain insults that worsen neurological outcomes. Post-traumatic hyperthermia may result from hypothalamic dysfunction due to direct injury, cerebral inflammation, metabolic derangements, or early infectious processes. Despite extensive global research, local data regarding early hyperthermia as a prognostic indicator in severe TBI remains scarce in Pakistan. Objective: To determine the predictive value of early hyperthermia on mortality and neurological outcomes in patients presenting with moderate to severe traumatic brain injury at JPMC, Karachi. Methods: A prospective observational study was conducted at JPMC over six months. One hundred patients aged 13 years and above, presenting within four hours of acute head trauma with documented fever within three days, were enrolled. Patients with polytrauma, congenital CNS anomalies, vascular lesions, tumors, or spinal injuries were excluded. Temperature measurements, Glasgow Coma Scale (GCS), radiological findings, and neurological assessments were recorded. Outcomes were assessed using the Glasgow Outcome Scale (GOS) at three months. Data were analyzed using SPSS v22. Results: Early hyperthermia (≥38°C within the first 72 hours) was recorded in 48% of patients. Mortality at three months was significantly higher in hyperthermic patients (43.7%) compared to normothermic patients (21.1%). Poor neurological outcome (GOS 1–3) occurred in 68.7% of the hyperthermia group versus 39.4% of the normothermia group. Multivariate logistic regression demonstrated that hyperthermia was an independent predictor of poor outcome (OR 2.81, p = 0.008) after adjusting for age, initial GCS, and CT findings. Conclusion: Hyperthermia within the early post-injury period is a strong and independent predictor of poor neurological outcomes and increased mortality in severe TBI patients. Early targeted temperature management and aggressive fever control should be considered integral components of acute neurocritical care protocols to improve outcomes in this population.