Carolyn A Magee1, Melissa L Thompson Bastin2, Katelyn Graves3, Donna Burgess2, Melissa Nestor2, John R Lamm4, Aaron M Cook2. 1. Medical University of South Carolina Hospital Authority, Department of Pharmacy Services, Charleston, South Carolina. Electronic address: mageeca@musc.edu. 2. University of Kentucky HealthCare, Department of Pharmacy Services, Lexington, Kentucky; University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science, Lexington, Kentucky. 3. Norton Audubon Hospital, Department of Pharmacy, Louisville, Kentucky. 4. Norton Audubon Hospital, Department of Pharmacy, Louisville, Kentucky; University of Kentucky HealthCare, Department of Graduate Medical Education, Lexington, Kentucky.
Abstract
BACKGROUND: Fever occurs in the majority of subarachnoid hemorrhage (SAH) patients. Nearly 50% of SAH patients have noninfectious fevers. Data are lacking describing the effects of fever burden in the SAH patient population. METHODS: This was a single-center, retrospective observational cohort study in patients more or equal to 18 years of age with a diagnosis of nontraumatic SAH admitted to an ICU between January 1, 2010 and September 1, 2015. Exclusion criteria were SAH secondary to trauma or admission for more than 48 hours. Temperature measurements, demographic data, and other pertinent information were collected from Day 0 to Day 13. Daily fever burden was calculated for each patient by calculating an area under the curve. RESULTS: A total of 194 subjects were included. The mean study period maximum temperature (Tmax) for all 194 patients was 40.8 ± 0.83°C. The mean overall fever burden for all 194 patients was 89.2 ± 99.59°C h more than 37°C. The overall fever burden peaked on day 5 and declined thereafter. Fever burden, Tmax, and length of stay in the hospital were all significantly associated with receipt of antibiotics. Only Tmax was associated with poor outcome. The 31 patients who had fever but no identified cause of infection received 1000 doses of antibiotics or 32.25 doses per patient. CONCLUSION: Fever is common in SAH patients and is associated with antibiotic use, infection, vasospasm, and poor outcome. Some SAH patients may receive antibiotics unnecessarily for noninfectious fever. Clinicians should consider using site-specific parameters related to infection rather than systemic symptoms such as fever to evaluate infection in SAH patients.
BACKGROUND:Fever occurs in the majority of subarachnoid hemorrhage (SAH) patients. Nearly 50% of SAHpatients have noninfectious fevers. Data are lacking describing the effects of fever burden in the SAHpatient population. METHODS: This was a single-center, retrospective observational cohort study in patients more or equal to 18 years of age with a diagnosis of nontraumatic SAH admitted to an ICU between January 1, 2010 and September 1, 2015. Exclusion criteria were SAH secondary to trauma or admission for more than 48 hours. Temperature measurements, demographic data, and other pertinent information were collected from Day 0 to Day 13. Daily fever burden was calculated for each patient by calculating an area under the curve. RESULTS: A total of 194 subjects were included. The mean study period maximum temperature (Tmax) for all 194 patients was 40.8 ± 0.83°C. The mean overall fever burden for all 194 patients was 89.2 ± 99.59°C h more than 37°C. The overall fever burden peaked on day 5 and declined thereafter. Fever burden, Tmax, and length of stay in the hospital were all significantly associated with receipt of antibiotics. Only Tmax was associated with poor outcome. The 31 patients who had fever but no identified cause of infection received 1000 doses of antibiotics or 32.25 doses per patient. CONCLUSION:Fever is common in SAHpatients and is associated with antibiotic use, infection, vasospasm, and poor outcome. Some SAHpatients may receive antibiotics unnecessarily for noninfectious fever. Clinicians should consider using site-specific parameters related to infection rather than systemic symptoms such as fever to evaluate infection in SAHpatients.