Evidence-based Fever Management in Patients with Traumatic Brain Injury: A Case Study

Abstract

Fever management in patients with traumatic brain injury (TBI) has been a challenge in neurosurgical
nursing practice since fever has impact to the higher mortality and disability including length of stay. In
addition, evidence-based guideline for fever management in TBI patients is little known to support nursing
practice of how to implement. This article aims at presenting an evidence-based nursing intervention for
fever management in TBI patients. By applying an evidence-based care approach, two case studies selected
from SICU/trauma ward in a tertiary hospital in Songkhla province were reviewed to identify the pattern
of fever, factors related to fever among patients with TBI, and outcomes after implementing the guideline.
The results revealed that patterns of fever were different. In severe TBI case, high fever (> 38 oC)
from the day of admission throughout the frst 72 hours was observed and its cause related to neurogenic
fever. High fever with infection causes can lead to a high risk of IICP, and is then difcult to manage.
Another case with mild TBI had developed low grade fever (< 38 oC) within frst 72 hours as a result of
multiple injuries. Non-specifc factors of fever caused by inflammatory response of wound healing and
operation were easier to manage. Hence, the greater the severity of TBI, the more comprehensive fever
management required. In addition, factors related to fever management were related to the nurses’ knowledge,
health care team participation, and available resources. It is a challenge for nurses to manage fever in TBI
patient based on evidence-based guideline implementation in order to achieve better outcomes.