Fever with Special Emphasis on Neurogenic Fever in Traumatic Brain Injury Patients Admitted to the Trauma ICU: A Prospective Cohort Study

Background: Fever is a common and challenging problem in traumatic brain injury (TBI) patients in the intensive care unit (ICU), and distinguishing neurogenic fever (NF) from infectious fever is essential for appropriate management. Aim: To evaluate the incidence, clinical characteristics, and diagnostic markers of neurogenic fever in TBI patients and compare them with infectious fever in a trauma ICU setting. Methods: This prospective observational study was conducted in a tertiary care trauma ICU over one year and included 119 TBI patients with fever. Patients were assessed for demographic data, clinical features, laboratory markers (TLC, NLR, RDW, CRP), chest X-ray findings, microbiological cultures, and response to bromocriptine. Fever types were classified as infectious, neurogenic, mixed, or others. Statistical analysis was performed using SPSS version 26, with p < 0.05 considered significant. Results: The mean age was 47.57 ± 17.32 years, with male predominance (68.1%). Infectious fever was most common (70.6%), followed by neurogenic fever (12.6%) and mixed fever (9.2%). Neurogenic fever developed earlier after mechanical ventilation compared to infectious fever (3.27 ± 2.05 vs 6.91 ± 2.16 days, p < 0.001). Infectious and mixed fever were associated with significantly elevated inflammatory markers (TLC, NLR, CRP, RDW), whereas neurogenic fever showed relatively normal values. Neurogenic fever was characterized by a persistent plateau pattern and poor response to paracetamol. Heart rate variability, perspiration, and random blood sugar were not significantly associated with fever type. Although mortality was higher in infectious fever, no statistically significant association was found between fever type and 28-day mortality (p = 0.127). Conclusion: Neurogenic fever is an important non-infectious cause of fever in TBI patients in ICU. It can be differentiated from infectious fever using clinical pattern, early onset, inflammatory biomarkers, and response to therapy. Early identification may reduce unnecessary antibiotic use and improve critical care management.