Clinical Presentation Of Fever, Vasospasm And Clinical Neurologic Deterioration Following Subarachnoid Hemorrhage

2.50
Hdl Handle:
http://hdl.handle.net/10755/163776
Category:
Abstract
Type:
Presentation
Title:
Clinical Presentation Of Fever, Vasospasm And Clinical Neurologic Deterioration Following Subarachnoid Hemorrhage
Author(s):
Crago, Elisabeth
Author Details:
Elizabeth Crago, RN, MSN, Research Associate, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA, email: ecrago@pitt.edu
Abstract:
Purpose: The purpose of this study was to examine the relationship between fever, vasospasm and clinical neurological deterioration in subarachnoid hemorrhage patients. Hypothesis: Elevations in temperature were related to angiographic vasospasm and clinical neurological deterioration (CND). Framework: Fever (> 39oC) is an aggravating condition that persists in the majority of patients following a subarachnoid hemorrhage (SAH). Cerebral vasospasm occurs in 30-60% of individuals who survive a severe SAH within the first 14 days post hemorrhage, increasing the risk of neurologic deficit and death. Method: Prospective study of 38 SAH patients with a Fisher grade of > 2 admitted to the NeuroVascular ICU (NICU) were recruited. Temperature data were collected once/ minute using the Patient Data System (Hewlett Packard, Palo Alto, CA). Patients were monitored from admission to the NICU through day 14 or discharge from the unit. Clinical neurologic examinations were conducted every 2 hours and included assessment of level of consciousness, pupillary response, and motor and sensory function; the NIH Stroke Scale was completed daily. CND was defined as a deterioration of level of consciousness (a decline of > 2 GCS score) deterioration in pupillary response (brisk to sluggish or sluggish to fixed), or a decrease in the motor or sensory response. Vasospasm (none/mild, moderate, severe) was verified by cerebral angiograms as a narrowing in one of 28 segments of the cerebral vasculature; 81 angiograms were conducted on 39 patients. Results: Temperature ranged from 31.5 C to 40.4 C (M = 37.6; Mdn = 37.7; SD=0.89). Time from initial hemorrhage to fever ranged from 23 to 240 hours (M= 125.3, Mdn = 119, SD = 50.5). Of the 39 subjects, 30 developed CND, and 23 developed angiographic vasospasm [moderate n=23 (59%); severe n=11 (29%)]. Five/ 9 patients without CND exhibited moderate or severe angiographic vasospasm (55%) while 18/ 30 patients with CND exhibited vasospasm (60%) with a relative risk (RR) = 1.37. Nine/11 patients with severe vasospasm had a temp > 39 C (81%) while 19/28 patients without severe vasospasm had a temp > 39 C (67.8%) with a RR=2.13. Conclusions: Patients with severe vasospasm were more likely to experience a temperature > 39 C with associated clinical neurological deterioration. Implications for nursing practice and knowledge development: Fever has historically been documented in ICU patients. These results suggest that nurses may positively impact the outcomes of SAH patients by closely monitoring and controlling fevers in this specific population.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2001
Conference Name:
ENRS 13th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
Atlantic City, New Jersey, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleClinical Presentation Of Fever, Vasospasm And Clinical Neurologic Deterioration Following Subarachnoid Hemorrhageen_GB
dc.contributor.authorCrago, Elisabethen_US
dc.author.detailsElizabeth Crago, RN, MSN, Research Associate, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA, email: ecrago@pitt.eduen_US
dc.identifier.urihttp://hdl.handle.net/10755/163776-
dc.description.abstractPurpose: The purpose of this study was to examine the relationship between fever, vasospasm and clinical neurological deterioration in subarachnoid hemorrhage patients. Hypothesis: Elevations in temperature were related to angiographic vasospasm and clinical neurological deterioration (CND). Framework: Fever (> 39oC) is an aggravating condition that persists in the majority of patients following a subarachnoid hemorrhage (SAH). Cerebral vasospasm occurs in 30-60% of individuals who survive a severe SAH within the first 14 days post hemorrhage, increasing the risk of neurologic deficit and death. Method: Prospective study of 38 SAH patients with a Fisher grade of > 2 admitted to the NeuroVascular ICU (NICU) were recruited. Temperature data were collected once/ minute using the Patient Data System (Hewlett Packard, Palo Alto, CA). Patients were monitored from admission to the NICU through day 14 or discharge from the unit. Clinical neurologic examinations were conducted every 2 hours and included assessment of level of consciousness, pupillary response, and motor and sensory function; the NIH Stroke Scale was completed daily. CND was defined as a deterioration of level of consciousness (a decline of > 2 GCS score) deterioration in pupillary response (brisk to sluggish or sluggish to fixed), or a decrease in the motor or sensory response. Vasospasm (none/mild, moderate, severe) was verified by cerebral angiograms as a narrowing in one of 28 segments of the cerebral vasculature; 81 angiograms were conducted on 39 patients. Results: Temperature ranged from 31.5 C to 40.4 C (M = 37.6; Mdn = 37.7; SD=0.89). Time from initial hemorrhage to fever ranged from 23 to 240 hours (M= 125.3, Mdn = 119, SD = 50.5). Of the 39 subjects, 30 developed CND, and 23 developed angiographic vasospasm [moderate n=23 (59%); severe n=11 (29%)]. Five/ 9 patients without CND exhibited moderate or severe angiographic vasospasm (55%) while 18/ 30 patients with CND exhibited vasospasm (60%) with a relative risk (RR) = 1.37. Nine/11 patients with severe vasospasm had a temp > 39 C (81%) while 19/28 patients without severe vasospasm had a temp > 39 C (67.8%) with a RR=2.13. Conclusions: Patients with severe vasospasm were more likely to experience a temperature > 39 C with associated clinical neurological deterioration. Implications for nursing practice and knowledge development: Fever has historically been documented in ICU patients. These results suggest that nurses may positively impact the outcomes of SAH patients by closely monitoring and controlling fevers in this specific population.en_GB
dc.date.available2011-10-27T11:13:38Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:13:38Z-
dc.conference.date2001en_US
dc.conference.nameENRS 13th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationAtlantic City, New Jersey, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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