Background and Purpose-Many studies associate fever with poor outcome in patients with neurological injury, but this relationship is blurred by divergence in populations and outcome measures. We sought to incorporate all recent scholarship addressing fever in brain-injured patients into a comprehensive meta-analysis to evaluate disparate clinical findings. Methods-We conducted a Medline search for articles since January 1, 1995 (in English with abstracts, in humans) and hand searches of references in bibliographies and review articles. Search terms covered stroke, neurological injury, thermoregulation, fever, and cooling. A total of 1139 citations were identified; we retained 39 studies with 67 tested hypotheses contrasting outcomes of fever/higher body temperature and normothermia/lower body temperature in patients with neurological injury covering 14 431 subjects. A separate meta-analysis was performed for each of 7 outcome measures. Significance was evaluated with Zc developed from probability values or t values. Correlational effect size, r (es) , was calculated for each study and used to derive Cohen's d unbiased combined effect size and relative risk.

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The need for sufficient clinical evidence and the collection of real-world evidence (RWE) is at the forefront of medical device and drug regulations, however, the collection of clinical data can be a time consuming and costly process. The advancement of Digital Health Technologies (DHTs) is transforming the way health data can be collected, analysed, and shared, presenting an opportunity for the implementation of DHTs in clinical research to aid with obtaining clinical evidence, particularly RWE. DHTs can provide a more efficient and timely way of collecting numerous types of clinical data (e.g., physiological, and behavioural data) and can be beneficial with regards to participant recruitment, data management and cost reduction. Recent guidelines and regulations on the use of RWE within regulatory decision-making processes opens the door for the wider implementation of DHTs. However, challenges and concerns remain regarding the use of DHT (such as data security and privacy). Nevertheless, the implementation of DHT in clinical research presents a promising opportunity for providing meaningful and patient-centred data to aid with regulatory decisions.