Fever Burden and Neurological Outcome in Traumatic Spinal Cord Injury.

Fever is a frequent complication after traumatic spinal cord injury (TSCI) and may exacerbate secondary neurological damage through increased metabolic demand, inflammation, and impaired perfusion. Despite its potential impact, the role of fever in TSCI remains understudied, with only two prior studies addressing this issue, both using heterogeneous methodologies and yielding inconclusive results. Most existing work dichotomizes fever as present or absent, an approach that fails to capture the cumulative thermal stress experienced by the injured spinal cord. The concept of fever burden, integrating both intensity and duration of hyperthermia, may therefore provide a more accurate and clinically relevant measure. We conducted a retrospective observational study of adults with acute TSCI admitted to the Neurocritical Care Unit of the University Hospital of Geneva (2022-2024). Inclusion required surgical intervention within 48 h and continuous temperature monitoring; patients with concomitant severe traumatic brain injury or inability to provide consent were excluded. Core temperature was recorded minute-by-minute via bladder probe and aggregated to hourly values. Fever burden was defined as degree-hours above 37.9°C over the first 72 h. Neurological outcome was assessed with the American Spinal Injury Association (ASIA) Impairment Scale at admission and hospital discharge. Associations were evaluated using multivariable ordinal logistic regression adjusting for age, sex, and Injury Severity Score (ISS). Twenty-four patients were included (mean age 47.3 ± 19.2 years; 66.7% male; mean ISS 25.6 ± 12.7). Fever episodes occurred in 79.2% of patients, representing 15.8% of monitored time. Greater fever burden was independently associated with poorer neurological recovery (OR 1.29, 95% CI 1.14-1.53,