Doctoral graduate explores link between body temperature and traumatic brain injuries

Lori Madden, Ph.D., N.P., M.S.
Lori Madden

Lori Madden did not begin her nursing career with an interest in neuroscience. But after witnessing how those she cared for in the neurosurgical intensive care unit at UC Davis Medical Center recovered from traumatic brain injuries, she grew curious about what factors contributed to stronger recoveries. That interest led this 2014 graduate of the Doctor of Philosophy in Nursing Science and Health-Care Leadership Graduate Degree Program at the Betty Irene Moore School of Nursing at UC Davis to research that could create new protocols for how people with severe brain injuries are initially treated and improve their long-term recovery.

“While caring for them at the bedside, I wondered what we could do to help them not only survive, but survive better after their injuries,” Madden, a nurse practitioner, said.  “We have done clinical trials seeking to find something that can make a difference in survival. In traumatic brain injury research, we’ve not made much headway. I wanted to see if we can look at data to better understand the problems and try to identify what changes we might make to help improve their overall recovery.”

Traumatic brain injuries take a devastating toll. The latest data from the Centers for Disease Control and Prevention estimates that 1.7 million such injuries occur each year. Falls, motor-vehicle collisions and sports-related injuries can all result in brain injury, which can lead to long-term disability and even death. Madden perceived a lack of scientific evidence to guide how we deal with these neurological injuries. Her doctoral research sought to change that.

“On review of our traumatic brain injury cases, I found that many people developed a fever in the first 24 to 48 hours after injury, so I initially wondered if elevated temperature might correlate with worse outcomes,” Madden explained.  “We had studied induced hypothermia for brain-injured patients but did not find that it helped patients to have better survival. So I turned my attention to investigating the role body temperature plays in the quality of survival after these injuries.”

Madden looked at existing data from 398 moderately and severely injured patients to examine the impact of body temperature on their neurologic outcome up to six months after the initial injury. She found that if people have fever or are hypothermic the first 24 to 48 hours after injury, they do worse than those with normal body temperatures. Madden concluded targeted temperature management, or carefully controlling body temperature to maintain normothermia, following traumatic brain injury may help to reduce secondary brain injury resulting from abnormal body temperature. That approach could ultimately improve neurologic outcomes at a relatively low cost.

Madden continues working with individuals with neurologic injury and illness as an acute-care nurse practitioner at UC Davis Health’s Department of Neurological Surgery. She is also an associate clinical professor at the UC San Francisco School of Nursing. She credits her doctoral education with providing a broader view of health and health care, a deeper appreciation of the benefits of interdisciplinary teams in science and at the bedside and igniting plans for next steps in her program of research.

“My opportunities as a student to think about care more broadly and approach my practical curiosities through collaboration and teamwork transfers well into the clinical setting,” Madden said. “I want to see what we can do on a patient-by-patient basis and system wide to affect how we care for people and how well they survive.”