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

Abstract

Purpose:

Previous work identified a sub-group of trauma patients at risk for bacteremia who presented with signs of infection, including fever. A majority were older adult falls who had early onset bacteremia.

Hypothesis:

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

Methods:

Trauma patients ≥18 years, drawn from a system-wide electronic medical record (EMR) (2017–2020), were included. Fever+ patients (temperature >38°C) were compared with Fever− patients (36°C–38°C). Multi-variable logistic regressions assessed the association of fever status with outcomes. The interaction between fever, age, and outcomes was assessed.

Results:

A total of 140,647 patients were included from 89 centers. Eight hundred ninety (0.6%) were Fever+ and had worse unadjusted outcomes. After adjustment, Fever+ patients had significantly greater mortality (adjusted odds ratios [aOR], 95% confidence interval: 1.05 [1.04–1.07]), intensive care unit use (1.08 [1.04–1.11]), and ventilator use (1.11 [1.09–1.13]). Fever+ status was associated with a significantly larger aOR of severe sepsis in older versus younger patients (≥65 y: 1.12 [1.11–1.13]; <65 y: 1.04 [1.03–1.05]). Fever+ status was also associated with a significantly larger aOR of bacteremia in older versus younger patients (≥65 y: 1.09 [1.08–1.10]; <65 y: 1.04 [1.03–1.05]).

Implications:

Although uncommon, fever at presentation is an ominous sign for trauma patients and portends significantly greater risks for bacteremia, sepsis, and mortality. These risks increase with age. These findings suggest older adults who present with fever warrant early aggressive intervention and may sustain injury as a consequence of debility from systemic infection.