Traumatic brain injury (TBI) is a leading cause of death and disability, contributing to one third of all injury- related deaths in the U.S. There has been an increased awareness of TBI as the "signature wound" of current military conflict. Despite best-care practices based on published guidelines, many patients have poor outcomes due to secondary injuries. Secondary injuries occur after the primary trauma. Failure to treat secondary injury leads to lengthened intensive care unit and hospital stays and increased mortality. Identification of strategies that can prevent or minimize secondary injuries results in improved health of individuals, families, communities, and populations. Temperature management is one method to reduce secondary injury. However, the optimal goal for body temperature following TBI has not been identified. The purpose of this secondary data analysis of 456 patients is to examine the association between body temperature and neurologic outcome as measured by Extended Glasgow Outcome Scale (GOS-E) in patients ages 16 years and older after blunt moderate or severe TBI. We propose that features of body temperature over 96 hours after injury predict 6-month GOS-E adjusting for confounders.
The aims of this training proposal are to: 1) Characterize the severity and duration of time the patien experiences abnormal body temperature during the first 96 hours after moderate or severe TBI;2) Determine if aberrant temperature exposure during this period predicts neurologic outcome adjusting for confounders;3) Determine if rate of aberrant temperature correction during this period predicts neurologic outcome adjusting for confounders;and 4) Gather an interdisciplinary panel to validate findings and identify potential implications for future research nursing practice Multiple ordinal regression analysis will be used to estimate the relative contribution of IMPACT variables (age, GCS motor score, pupillary reaction, hypoxia, hypotension, initial head CT classification, traumatic subarachnoid hemorrhage or epidural mass on CT, serum glucose, and serum hemoglobin) in predicting GOS- E. Proportion of variation in GOS-E explained by IMPACT variables will be estimated. Temperature volume will be added to the model and change in variance of GOS-E explained by the addition of temperature volume will be estimated. Then, the rate of change in temperature across the 96-hour period will be added and change in variance of GOS-E explained by the addition of the rate of change in temperature will be estimated. Meeting these study aims, we may develop a more useful predictive model, which is readily translatable to nursing practice. We seek to build the scientific foundation for nursing practice. As nurses monitor, document and treat patient body temperature, this research has the potential to influence rewarming rates in trauma resuscitation with TBI, temperature management goals after TBI, and timing of interventions to prevent/minimize fever after TBI. Finally, temperature management following TBI may improve outcomes at a relatively low cost.
This proposal has high impact given the prevalence and societal effect of traumatic brain injury. Traumatic brain injury contributes to one third of all injury-related deaths in the U.S. Despite best-care practices based on published guidelines, many patients have poor outcomes due to secondary injuries. Nurses are in an excellent position to intervene to manage body temperature. New discoveries from this research may help to prevent and/or minimize disability and death by reducing secondary injury resulting from abnormal body temperature.