• Jinn-Rung Kuo, Chong-Jeh Lo, Che-Chuan Wang, Chin-Li Lu, Shu-Chin Lin, and Chiao-Fang Chen.
• Institute of Clinical Medicine, School of Medicine, National Cheng-Kung University, Tainan, Taiwan.
• J Clin Neurosci. 2011 Aug 1;18(8):1059-63.

AbstractThe aim of this study was to evaluate the relationship between superficial temporal artery temperature (Tt), rectal temperature (Tr) and intracranial temperature (ICT) when attempting to keep the brain in a normothermic condition in patients with severe traumatic brain injury (TBI). We also compared the incidence of temperature gradient reversal in patients who survived (survivors) and patients who did not (non-survivors) and the difference in temperature gradient reversal between survivors and non-survivors. Tr is normally lower than and ICT and temperature gradient reversal, when Tr exceeds ICT, has been demonstrated to be an early sign of brain death. A total of 28 patients with severe TBI were enrolled retrospectively in our study between November 2008 and February 2010. Each patient's Tt, Tr and ICT was recorded every hour for 4 days. Our results show that the frequency of brain hyperthermia in our participants (ICT>38°C) was 17.7%. Using a paired t-test and Bland-Altman plots, it was shown that a significant temperature difference existed between Tt, Tr and ICT (p<0.001). The use of Spearman's correlation method revealed that Tt, Tr and ICT were positively correlated (p<0.001). Brain death occurred in five patients at a mean of 9.6 hours (range: 8-12 hours) after a temperature gradient reversal between Tt, Tr and ICT. Fisher's exact test showed that there was a significant difference in the incidence of temperature gradient reversal between Tt, Tr and ICT in survivors and non-survivors (p<0.001). We conclude that a significant temperature difference exists between Tt, Tr and ICT when maintaining brain normothermia. The daily practice of non-invasive Tt measurement may cause doctors to underestimate ICT; reversal of the ICT and Tt and/or Tr temperatures could be an early marker of a poor prognosis for patients with severe TBI.Copyright © 2011 Elsevier Ltd. All rights reserved.

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