Effect of early nutrition on deaths due to severe traumatic brain injury.
OBJECTIVE
Traumatic brain injury (TBI) remains a serious public health crisis requiring continuous improvement in pre-hospital and inhospital care. This condition results in a hypermetabolic state that increases systemic and cerebral energy requirements, but achieving adequate nutrition to meet this demand has not been a priority in reducing death due to TBI. The effect of timing and quantity of nutrition on death within the first 2 weeks of injury was analyzed in a large prospective database of adult patients with severe TBI in New York State.


METHODS
The study is based on 797 patients with severe TBI (Glasgow Coma Scale [GCS] score < 9) treated at 22 trauma centers enrolled in a New York State quality improvement program between 2000 and 2006. The inhospital section of the prospectively collected database includes information on age, initial GCS score, weight and height, results of CT scanning, and daily parameters such as pupillary status, arterial hypotension, GCS score, and number of calories fed per day.


RESULTS
Patients who were not fed within 5 and 7 days after TBI had a 2- and 4-fold increased likelihood of death, respectively. The amount of nutrition in the first 5 days was related to death; every 10-kcal/kg decrease in caloric intake was associated with a 30-40% increase in mortality rates. This held up even after controlling for factors known to affect mortality, including arterial hypotension, age, pupillary status, initial GCS score, and CT scan findings.


CONCLUSIONS
Nutrition is a significant predictor of death due to TBI. Together with prevention of arterial hypotension, hypoxia, and intracranial hypertension it is one of the few therapeutic interventions that can directly affect TBI outcome.
Härtl
Roger
R
Department of Neurological Surgery, Weill Cornell Medical College, New York, New York 10021, USA. roger@hartlmd.net
Gerber
Linda M
LM
Ni
Quanhong
Q
Ghajar
Jamshid
J
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000401:mortality* / Q000628:therapy*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D009752:Nutritional Status; D018529:Nutritional Support / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data