Fever in the Trauma Bay: A Marker for Greater Risk of Adverse Outcomes?

Author(s):
Samir Fakhry; Yan Shen; Gina Berg; James Dunne; Parker Hu; Darrell Hunt; Mark Mckenney; NIcholas Sheets; Robert Sliter; Matthew Carrick

Background:

Previous work identified a subgroup of patients at risk for bacteremia who presented as trauma patients with signs of systemic infection, including fever. A majority were older adults who sustained falls and had early onset of bacteremia suggesting systemic infection may have preceded the injury.

Hypothesis:

Fever in the trauma bay is associated with greater risk of adverse outcomes and identifies patients who might benefit from early initiation of interventions for sepsis.

Methods:

Trauma patients ≥18 yrs (activations and consultations) admitted 2017-20, drawn from a system-wide EMR, were included. Fever+ patients (Temp >38^oC) were compared to Fever– patients (36-38^oC); Temp assessed ≤30 mins of arrival. Multivariable logistic regressions assessed the association of ED fever status with mortality, bacteremia, severe sepsis, ICU use, and ventilation use, adjusting for covariates. The interaction between Fever, age, and outcomes was assessed.

Results:

140,647 patients were included from 89 trauma centers. 890 (0.6%) were Fever+ and had worse unadjusted outcomes (Table). After adjustment, compared to Fever– patients, Fever+ patients had significantly higher mortality (aOR, 95%CI: 1.05 [1.04–1.07]), ICU use (1.08 [1.04–1.11]), and ventilator use (1.11 [1.09–1.13]). Age significantly interacted with Fever and two outcomes: Fever+ status was associated with a significantly larger aOR of severe sepsis in older vs younger pts (≥65 yrs: 1.12 [1.11–1.13]; <65 yrs: 1.04 [1.03–1.05]). Fever+ status was also associated with a significantly larger aOR of bacteremia in older vs younger pts (≥65 yrs: 1.09 [1.08–1.10]; <65 yrs: 1.04 [1.03–1.05]).

Conclusions:

Although uncommon, fever at presentation is an ominous sign for trauma patients and portends significantly higher risks for bacteremia, severe sepsis, and mortality. The risk of sepsis and bacteremia in those with fever increased with age. These findings suggest older adults who present with fever warrant early aggressive intervention. The possibility they sustained injury as a consequence of debility from systemic infection is an avenue for further investigation.