Factors associated with persistent postoperative hyperthermia in pediatric craniocerebral injury: a retrospective cohort study and preliminary risk score

BACKGROUND: Fever represents a common postoperative complication in pediatric patients with craniocerebral injury. The present study aimed to investigate the prevalence and factors independently associated with persistent postoperative hyperthermia in children following craniocerebral injury surgery, thereby providing evidence to inform clinical nursing practice. METHODS: A retrospective cohort study was conducted involving pediatric patients who underwent craniocerebral injury surgery. Patients were stratified into two groups: the persistent postoperative hyperthermia group and the non-persistent postoperative hyperthermia group, based on the presence of persistent postoperative hyperthermia (defined as a body temperature ≥ 38.5 °C, sustained or recurrent, for a cumulative duration exceeding 36 h within the first 72 h postoperatively). RESULTS: A total of 238 pediatric patients who underwent craniocerebral injury surgery were included. The incidence of persistent postoperative hyperthermia was 28.99%. Multivariate logistic regression analysis revealed that age ≤ 5 years (odds ratio [OR] = 3.516, 95% confidence interval [CI]: 2.108-5.854), severe craniocerebral injury (OR = 6.442, 95%CI: 3.285-12.638), elevated postoperative intracranial pressure (≥ 20 mmHg, OR = 4.598, 95%CI: 2.683-7.895), postoperative drainage tube indwelling time ≥ 72 h (OR = 4.002, 95%CI: 2.356-6.817), pulmonary infection (OR = 5.438, 95%CI: 3.126-9.457), and methicillin-resistant Staphylococcus aureus (MRSA) infection (OR = 3.078, 95%CI: 1.756-5.392) were independently associated with persistent postoperative hyperthermia. A preliminary predictive model constructed based on these factors had a sensitivity of 0.754, specificity of 0.879, and Youden index of 0.633 in the cohort, but these performance estimates are likely optimistic and require external validation. CONCLUSION: Persistent postoperative hyperthermia is a prevalent complication in children following craniocerebral injury surgery, which is influenced by multiple factors. The identified factors are independently associated with this outcome, although causality cannot be inferred. The exploratory predictive model, while showing favorable discrimination in this sample, must be externally validated before clinical application.