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Factors associated with persistent postoperative hyperthermia in pediatric craniocerebral injury: a retrospective
Na Yan1, Xiaoyan Zhou1, Fujia Zhuang1
1SICU, Children's Hospital of Nanjing Medical University, No.72, Guangzhou Road, Nanjing City, Jiangsu Province, China.
Insights
Persistent postoperative hyperthermia is common in children after craniocerebral injury surgery. Key risk factors include younger age, severe injury, high intracranial pressure, prolonged drainage, and infections like MRSA.
Area of Science:
- Pediatric Neurosurgery
- Critical Care Medicine
- Infectious Diseases
Background:
- Fever is a frequent complication post-craniocerebral injury surgery in children.
- Understanding persistent postoperative hyperthermia is crucial for clinical nursing practice.
Purpose of the Study:
- To determine the prevalence of persistent postoperative hyperthermia in pediatric patients undergoing craniocerebral injury surgery.
- To identify factors independently associated with this complication.
Main Methods:
- Retrospective cohort study of 238 pediatric patients.
- Defined persistent postoperative hyperthermia as temperature ≥38.5°C for >36 hours within 72 hours post-surgery.
- Used multivariate logistic regression to identify associated factors.
Main Results:
- The incidence of persistent postoperative hyperthermia was 28.99%.
- Independently associated factors included younger age (≤5 years), severe craniocerebral injury, elevated intracranial pressure, prolonged drainage tube indwelling time, pulmonary infection, and MRSA infection.
- A preliminary predictive model showed good performance but requires external validation.
Conclusions:
- Persistent postoperative hyperthermia is a significant complication in pediatric craniocerebral surgery patients.
- Several clinical and infectious factors are independently associated with this condition.
- The predictive model needs external validation before clinical use.
Background:
Fever represents a common postoperative complication in pediatric patients with craniocerebral injury. The present study aimed to investigate the prevalence and factors independently associated with persistent postoperative hyperthermia in children following craniocerebral injury surgery, thereby providing evidence to inform clinical nursing practice.
Methods:
A retrospective cohort study was conducted involving pediatric patients who underwent craniocerebral injury surgery. Patients were stratified into two groups: the persistent postoperative hyperthermia group and the non-persistent postoperative hyperthermia group, based on the presence of persistent postoperative hyperthermia (defined as a body temperature ≥ 38.5 °C, sustained or recurrent, for a cumulative duration exceeding 36 h within the first 72 h postoperatively).
Results:
A total of 238 pediatric patients who underwent craniocerebral injury surgery were included. The incidence of persistent postoperative hyperthermia was 28.99%. Multivariate logistic regression analysis revealed that age ≤ 5 years (odds ratio [OR] = 3.516, 95% confidence interval [CI]: 2.108-5.854), severe craniocerebral injury (OR = 6.442, 95%CI: 3.285-12.638), elevated postoperative intracranial pressure (≥ 20 mmHg, OR = 4.598, 95%CI: 2.683-7.895), postoperative drainage tube indwelling time ≥ 72 h (OR = 4.002, 95%CI: 2.356-6.817), pulmonary infection (OR = 5.438, 95%CI: 3.126-9.457), and methicillin-resistant Staphylococcus aureus (MRSA) infection (OR = 3.078, 95%CI: 1.756-5.392) were independently associated with persistent postoperative hyperthermia. A preliminary predictive model constructed based on these factors had a sensitivity of 0.754, specificity of 0.879, and Youden index of 0.633 in the cohort, but these performance estimates are likely optimistic and require external validation.
Conclusion:
Persistent postoperative hyperthermia is a prevalent complication in children following craniocerebral injury surgery, which is influenced by multiple factors. The identified factors are independently associated with this outcome, although causality cannot be inferred. The exploratory predictive model, while showing favorable discrimination in this sample, must be externally validated before clinical application.
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