Fever During Rehabilitation in Patients With Traumatic Spinal Cord Injury: Analysis of 392 Cases From a National Rehabilitation Hospital in Turkey

Abstract

Objective: To determine the incidence and etiology of fever and the risk factors related to fever in adults with spinal cord injury (SCI) at the rehabilitation stage. Design/Subjects: A retrospective examination of records of 392 consecutive adult patients with traumatic SCI who received inpatient rehabilitation program. Setting: A national rehabilitation center in Turkey. Outcome Measures: Incidence and etiology of fever, period of hospitalization (days). Results: A total of 187 patients (47.7%) had fever at least once during their rehabilitation program. The most common etiology was urinary tract infection. The rate of fever occurrence was significantly higher in patients with complete SCI (P 5 0.001). In patients with fever, the use of an indwelling catheter was significantly higher compared with clean intermittent catheterization and spontaneous voiding (P 5 0.001). The hospitalization period of patients with fever was significantly longer than that of patients without fever (P 5 0.006). Conclusions: A high rate of fever was seen in patients with SCI during rehabilitation. Fever was caused by various infections, of which urinary tract infection was the most common. Patients with motor complete injuries and those with permanent catheters constituted higher risk groups. Fever prolonged the length of rehabilitation stay and hindered active participation in the rehabilitation program.

Effects of chronic pain on quality of life and depression in patients with spinal cord injury

“…24 In another study from Turkey, 25 it was reported that the most common cause of SCI were falls (42.6%) and motor vehicle crash (38.5%), similarly as in the current study (35.0 and 34.2%, respectively). In addition, we found that the frequency of SCI due to falls was significantly higher in the painful group.…”

Does the CDC Definition of Fever Accurately Predict Inflammation and Infection in Persons With SCI?

“…They are also well below fever thresholds of 99.5°F and 99.9°F as previously reported in SCI literature. 5,18 Most notably, they were also below 98.6°F, which is the "normal" core temperature of a healthy resting adult human. While this could have been a result of averaging 3 temperatures of the day of DI or due to administration of antipyretic medication as standard of care, it was a statistically significant rise from baseline temperature before DI (BT1) in both TP and PP groups (p = .0009 and .0216, respectively), so it was a true increase from baseline T au.…”

“…5,17,18 During acute hospitalization post SCI, 73% to 81% of fevers have been reported to be of infectious etiology, with urinary tract and respiratory infections being most common. 5,17,19,20 Furthermore, in a study of 88 SCI persons, temperatures greater than 101.5°F were more likely (but not always) to be of an infectious rather than noninfectious etiology.…”

“…If thermoregulatory dysfunction precludes a febrile response to infection and/or inflammatory processes, workup and treatment may be delayed and thus lead to increased morbidity, mortality, health care costs, and lengths of stay. 4,5,18 We hypothesize that the absence of fever as a presenting symptom may play a role in contributing to the great impact of pneumonia and septicemia on reducing life expectancy in persons with SCI.…”

“…5,18 In pilot data collection for this study, we also identified urinary tract infections as the most common cause, followed by pneumonia; however, due to inconsistencies in coding across various VA hospitals for infection, we were unable to establish fever threshold that is more sensitive in detecting infection in these persons. [33][34][35] Based on SCI data presented here, one could argue that a lower fever threshold may be needed in the SCI population to detect infectious/inflammatory processes sooner than later.…”