Remember that not All Fever in the Burn Patient is Due to Infection
Oliver A. Varban MD
James H. Holmes IV MD
Virtually all burn patients have elevated core body temperatures and even a leukocytosis. Thus, fever in burn patients is not a reliable indicator of infection. One study in children found that fever had no predictive value for the presence of infection and physical examination was a more reliable source of information about wound infection and sepsis. Furthermore, routine blood cultures have been shown to be of little value in working up a fever in burn patients.
Watch Out For
Mild hyperthermia in the first 24 hours following injury is almost always the result of pyrogen release. The three endogenous pyrogens that mediate fever are interleukin-1 (IL-1), tumor necrosis factor-α (TNF-α, cachetin), and interferon-γ. In addition to inducing fever, these pyrogens also modulate a large number of host defense responses. After 72 hours, burn patients develop systemic inflammatory response syndrome (SIRS), characterized by tachycardia, relative hypotension, and hyperthermia, which are the classic signs of sepsis that can occur without an infectious source. In fact, body temperature may be as high as 39°C (102.2°F) and the leukocyte count may be as high as 20,000 cells/mL during satisfactory recovery. Thus, elevation of body temperature above normal, leukocytosis, and other signs of inflammation are common among burn patients and should be expected.