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• W2316946459 abstract "Introduction: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Fever is associated with worsened outcomes in brain injury and may be unresponsive to therapy in over 40% of children with severe TBI. Acetaminophen (APAP) is often used to treat fever, and may be given as a low dose, 10 mg/kg or high dose, 15 mg/kg. Methods: This is a retrospective cohort study of pediatric patients admitted to the Pediatric Intensive Care Unit with severe TBI (Glasgow Coma Scale Score 8 or less) who received APAP for treatment of fever. APAP was given in standard doses of 10 mg/Kg (low dose) or 15 mg/Kg (high dose) every 4–6 hours. Fever (>38.0º C) at hours 2 and 4 after drug administration were evaluated as dichotomous outcome variables. Subject nested within dose was modeled as a random effect in a generalized linear mixed random effects model with a binomial distribution and a logit link (Glimmix procedure, SAS 9.3). The fixed effects were baseline temperature, dose, and the interaction of dose and baseline temperature. A second model included only the dose effect. Results: In 103 children with severe TBI, there were 92 instances with complete data and baseline temperature between 38.5–39.5º C (n=74 and 18 for low and high dose respectively). Baseline temperatures >/=39.5º C were not included in the analysis because only low dose APAP was administered in such instances. At 2 hours post administration all fixed effects were not significant (p > 0.12), and the probability of fever was 67% for both high and low dose APAP. At 4 hours post APAP administration baseline temperature and dose by baseline temperature interaction were not significant (p > 0.11), however with dose as a fixed effect, the probability of fever was lower in the high dose group compared to low dose APAP administration (27% and 64% respectively; p = 0.0145). Conclusions: In our cohort, children with severe TBI and fever who received high dose APAP had lower probability of fever 4 hours post administration compared children who received low dose APAP. Prospective studies are needed to determine the optimal APAP dose in children with severe TBI." @default.
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• W2316946459 date "2013-12-01" @default.
• W2316946459 modified "2023-10-18" @default.
• W2316946459 title "460" @default.
• W2316946459 doi "https://doi.org/10.1097/01.ccm.0000439604.40649.30" @default.
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