and Purpose-Therapeutic temperature modulation is widely used in neurocritical care but commonly causes shivering, which can hamper the cooling process and result in increases in systemic metabolism. We sought to validate a grading scale to assist in the monitoring and control of shivering. Methods-A simple 4-point Bedside Shivering Assessment Scale was validated against continuous assessments of resting energy expenditure, oxygen consumption, and carbon dioxide production as measured by

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... t calorimetry. Therapeutic temperature modulation for fever control or the induction of hypothermia was achieved with the use of a surface or endovascular device. Expected energy expenditure was calculated using the Harris-Benedict equation. A hypermetabolic index was calculated from the ratio of resting of energy expenditure to energy expenditure. Results-Fifty consecutive cerebrovascular patients underwent indirect calorimetry between January 2006 and June 2007. Fifty-six percent were women, and mean age 63Ϯ16 years. The majority underwent fever control (nϭ40 [80%]) with a surface cooling device (nϭ44 [87%]) and had signs of shivering (Bedside Shivering Assessment Scale Ͼ0, 64% [nϭ34 of 50]). Low serum magnesium was independently associated with the presence of shivering (Bedside Shivering Assessment Scale Ͼ0; OR, 6.8; 95% CI, 1.7 to 28.0; Pϭ0.01). The Bedside Shivering Assessment Scale was independently associated with the hypermetabolic index (Wϭ16.3, PϽ0.001), oxygen consumption (Wϭ26.3, PϽ0.001), resting energy expenditure (Wϭ27.2, PϽ0.001), and carbon dioxide production (Wϭ18.2, PϽ0.001) with a high level of interobserver reliability ( w ϭ0.84, 95% CI, 0.81 to 0.86). Conclusion-The Bedside Shivering Assessment Scale is a simple and reliable tool for evaluating the metabolic stress of shivering. (Stroke. 2008;39:3242-3247.)