Antipyretic treatment of noninfectious fever in children with severe traumatic brain injury

Objective: The purpose of this study was to describe the treatment of noninfectious fever in children with severe traumatic brain injury (TBI). Materials and methods: We conducted a retrospective study to compare type of and response to antipyretic treatment strategies in children less than or equal to 17 years and Glasgow Coma Scale (GCS) score less than 9. Results: The average admission GCS score was 4. Forty children (35 boys, 5 girls), age 7.8 ± 5.2 years, had noninfectious fever. Seventy percent (28 of 40) received acetaminophen only, and 30% (12 of 40) received acetaminophen plus either ibuprofen or physical cooling. Time to next febrile episode was longer in patients receiving combination therapy than those receiving monotherapy (p = 0.03). Fever refractory to treatment dose or strategy occurred in more than 40% of the patients. Conclusions: Early combination antipyretic therapy may be needed to effectively maintain normothermia in children with severe TBI.