Does the CDC Definition of Fever Accurately Predict Inflammation and Infection in Persons With SCI?

Area of Science:

• Neurology
• Infectious Diseases
• Critical Care Medicine

Background:

• Spinal cord injury (SCI) patients face reduced life expectancy due to pneumonia and septicemia.
• Fever is a common infection indicator, but SCI can impair thermoregulation, delaying diagnosis.
• Altered febrile response in SCI necessitates understanding core temperature during illness.

Purpose of the Study:

• To assess core body temperature in spinal cord injury patients during infection/inflammation.
• To determine the frequency of CDC-defined fever ( >100.4°F) in SCI patients with diagnosed infection/inflammation.
• To evaluate baseline body temperatures in SCI patients.

Main Methods:

• Retrospective review of hospitalized SCI patients over 5 years.
• Inclusion criteria: diagnosis of infection/inflammation (DI) defined by serum leukocytosis.
• Aural temperatures (T_au) were recorded on the day of DI, 7 days prior, and 14 days after.

Main Results:

• Average T_au at DI was 98.2°F in both tetraplegia (TP) and paraplegia (PP) groups.
• Only 11.6%–14% of DI episodes in SCI patients met the >100.4°F fever criteria.
• Baseline temperatures were subnormal, ranging from 97.9°F to 98.0°F.

Conclusions:

• Spinal cord injury patients with leukocytosis infrequently exhibit CDC-defined fever.
• Subnormal baseline temperatures and infrequent fever suggest thermoregulatory dysfunction in SCI.
• A temperature >100.4°F is an insensitive marker for infection/inflammation in SCI; alternative symptoms require clinical vigilance.