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Environmentally responsive temperature instability in pediatric spinal cord injury
D E McLean1, J Kearney, M F Cawley
1Division of Physical Medicine and Rehabilitation, The Glenrose Rehabilitation Hospital, The University of Alberta, Canada.
Insights
Environmentally responsive temperature instability affects some pediatric patients with spinal cord injury (SCI). Early recognition and environmental manipulation protocols can successfully manage these temperature fluctuations in SCI rehabilitation.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Environmental Medicine
Background:
- Hospitalized pediatric patients with spinal cord injury (SCI) may experience temperature instability.
- The influence of environmental factors on temperature regulation in this population is not well understood.
Purpose of the Study:
- To investigate the frequency and clinical significance of environmentally responsive temperature instability in pediatric SCI patients.
- To identify characteristics of patients affected by this phenomenon.
Main Methods:
- Prospective collection of temperature data and clinical responses in pediatric SCI patients (n=54) over two years.
- Definition of hypothermic and hyperthermic events, with analysis of those linked to environmental manipulation.
- Retrospective review to exclude other causes of temperature fluctuation.
Main Results:
- 79 events of temperature instability (65 hypothermia, 14 hyperthermia) were analyzed in 12 patients (22%).
- Patients with environmentally responsive temperature instability had more recent injuries, longer hospital stays, and higher ventilator dependence.
- No adverse clinical outcomes were associated with these temperature fluctuations.
Conclusions:
- A subset of pediatric SCI patients exhibits environmentally responsive temperature instability.
- Early identification and environmental management strategies are effective in addressing these temperature fluctuations within SCI units.
Objective:
To study the frequency and clinical implications of environmentally responsive temperature instability in hospitalized pediatric patients with spinal cord injury (SCI).
Setting:
A tertiary level SCI rehabilitation unit located in a free standing children's hospital in Wilmington, DE, USA.
Study Design:
Temperature data and corresponding clinical responses were collected prospectively between January 1991 and June 1993. Fifty-four consecutive patients with SCI levels at or above T6 were admitted to the pediatric spinal cord injury rehabilitation unit over that time (4059 SCI days).
Methods:
Hypothermic events were defined as oral temperatures less than 35.0 degrees C or rectal temperatures less than 35.6 degrees C. Hyperthermic events were defined as oral temperatures greater than 38.0 degrees C or rectal temperatures greater than 38.4 degrees C. The events and the clinical responses were reviewed retrospectively and were used for subsequent analysis if there was evidence of clinical response to environmental manipulation within 4 hours of case identification, and other potential etiologies of temperature fluctuation could be excluded.
Results:
Sixty-five events of hypothermia (1.60%) and 14 events of hyperthermia (0.34%) were analyzed. Twelve patients (22%) accounted for all 79 events. Subjects with environmentally responsive temperature instability were more recently injured (P<0.001), had longer lengths of stay (P<0.001) and were more likely to be ventilator dependent (P<0.002) than those who did not have environmentally responsive temperature instability. There was no significant difference between the two groups in age, gender, level or etiology of the SCI. There were no adverse clinical outcomes as a result of the environmentally responsive temperature instability.
Conclusions:
Environmentally responsive temperature instability affects a select subset of pediatric aged spinal cord injured persons. Early recognition of the potential contribution of the environment to temperature fluctuation in this group has led to the successful utilization of a temperature instability protocol on our SCI unit.
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