What are the causes of fever in a patient with a crush injury?

From the Guidelines

Fever in a patient with crush injury is most commonly caused by infection, and thus, empiric antibiotic therapy should be considered as soon as possible after cultures are obtained, especially if the patient is seriously ill or deteriorating, as recommended by the American College of Critical Care Medicine and the Infectious Diseases Society of America 1. The causes of fever in a patient with crush injury can be multifaceted, including:

• Infection, which is a major concern and can arise from wound infections, pneumonia, urinary tract infections from catheterization, and bloodstream infections
• Systemic inflammatory response syndrome (SIRS) due to the release of damage-associated molecular patterns from injured tissues
• Rhabdomyolysis, leading to the release of myoglobin and other cellular contents that can cause fever
• Compartment syndrome, resulting from increased pressure within muscle compartments and leading to tissue necrosis and fever
• Deep vein thrombosis, a risk in immobilized patients that can cause fever
• Drug fever from medications used to treat the injury Management of fever in crush injury patients involves:
• Thorough infection workup, including blood cultures, wound cultures, chest X-ray, and urinalysis
• Administration of appropriate antibiotics if infection is confirmed, with initial empirical antibiotic therapy directed against likely pathogens, as suggested by the suspected source of infection and local knowledge of antimicrobial susceptibility patterns 1
• Adequate fluid resuscitation to prevent acute kidney injury from rhabdomyolysis, with individualized fluid administration based on considerations such as the scale of the disaster, environmental conditions, time spent under the rubble, length of extrication procedure, demographic characteristics of the victims, and volume status and urine flow 1
• Monitoring compartment pressures to prevent compartment syndrome
• DVT prophylaxis to reduce the risk of deep vein thrombosis
• Antipyretics like acetaminophen (500-1000mg every 6 hours) for symptom relief Early recognition and treatment of these causes are essential to prevent complications and improve outcomes in crush injury patients.

From the Research

Causes of Fever in Crush Injury

The causes of fever in a patient with crush injury can be attributed to various factors, including:

• Infections, which can be a major cause of fever in crush injury patients 2
• Non-infectious causes, such as tissue damage and inflammation resulting from the crush injury itself 3, 4
• Systemic manifestations of severe, traumatic muscle injury, also known as crush syndrome 5, 3
• Complications arising from the injury, such as compartment syndrome, hyperkalemia, rhabdomyolysis, and acute kidney injury 3

Infectious Causes

Infectious causes of fever in crush injury patients can include:

• Ventilator-associated pneumonia
• Catheter-associated urinary infection
• Catheter-related bloodstream infection
• Bacteremia
• Surgical site infection
• Intra-abdominal infection
• Ventriculitis
• Necrotizing soft tissue infection 2, 6

Non-Infectious Causes

Non-infectious causes of fever in crush injury patients can include:

• Tissue damage and inflammation resulting from the crush injury itself 3, 4
• Systemic manifestations of severe, traumatic muscle injury, also known as crush syndrome 5, 3
• Complications arising from the injury, such as compartment syndrome, hyperkalemia, rhabdomyolysis, and acute kidney injury 3