Environmentally responsive temperature instability in pediatric spinal cord injury

Objective: To study the frequency and clinical implications of environmenta lly responsive temperature instability in hospitalized pediatric patients w ith spinal cord injury (SCI), Setting: A tertiary level SCI rehabilitation unit located in a free standin g children's hospital in Wilmington, DE, USA. Study Design: Temperature data and corresponding clinical responses were co llected prospectively between January 1991 and June 1993. Fifty-four consec utive patients with SCI levels at or above T6 were admitted to the pediatri c 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 e vents were defined as oral temperatures greater than 38.0 degrees C or rect al temperatures greater than 38.4 degrees C. The events and the clinical re sponses were reviewed retrospectively and were used for subsequent analysis if there was evidence of clinical response to environmental manipulation w ithin 4 hours of case identification, and other potential etiologies of tem perature fluctuation could be excluded. Results: Sixty-five events of hypothermia (1.60%) and 14 events of hyperthe rmia (0.34%) were analyzed. Twelve patients (22%) accounted for all 79 even ts. Subjects with environmentally responsive temperature instability were m ore recently injured (P<0.001), had longer lengths of stay (P<0.001) and we re more likely to be ventilator dependent (P<0.002) than those who did not have environmentally responsive temperature instability. There was no signi ficant 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 envi ronmentally responsive temperature instability. Conclusions: Environmentally responsive temperature instability affects a s elect subset of pediatric aged spinal cord injured persons. Early recogniti on of the potential contribution of the environment to temperature fluctuat ion in this group has led to the successful utilization of a temperature in stability protocol on our SCI unit.