title: Evaluation of nutrition deficits in adult and elderly trauma patients.
abstract: BACKGROUND
  As metabolism is often escalated following injury, severely injured trauma patients are at risk for underfeeding and adverse outcomes.
  
  
  METHODS
  From an international database of 12,573 critically ill, adult mechanically ventilated patients, who received a minimum of 3 days of nutrition therapy, trauma patients were identified and nutrition practices and outcomes compared with nontrauma patients. Within the trauma population, we compared nutrition practices and outcomes of younger vs older patients.
  
  
  RESULTS
  There were 1279 (10.2%) trauma patients. They were younger, were predominantly male, had lower Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and had an overall lower body mass index compared with nontrauma patients. Eighty percent of trauma patients received enteral feeding compared with 78% of nontrauma patients. Trauma patients were prescribed more calories and protein yet received similar amounts as nontrauma patients. Nutrition adequacy was reduced in both trauma and nontrauma patients. Survival was higher in trauma patients (86.6%) compared with nontrauma patients (71.8%). When patients who died were included as never discharged, trauma patients were more rapidly discharged from the intensive care unit (ICU) and hospital. Within the trauma population, 17.5% were elderly (≥65 years). The elderly had increased days of ventilation, ICU stay, and mortality compared with younger trauma patients. In a multivariable model, age and APACHE II score, but not nutrition adequacy, were associated with time to discharge alive from the hospital.
  
  
  CONCLUSIONS
  Significant nutrition deficits were noted in all patients. Elderly trauma patients have worse outcomes compared with younger patients. Further studies are necessary to evaluate whether increased nutrition intake can improve the outcomes of trauma patients, especially geriatric trauma patients.
authors.affiliation: The University of Texas Health Science Center at Houston, Houston charles.e.wade@uth.tmc.edu.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.affiliation: The University of Texas Health Science Center at Houston, Houston.
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Kozar
authors.affiliation: The University of Texas Health Science Center at Houston, Houston.
authors.forename: Carmel B
authors.initials: CB
authors.lastname: Dyer
authors.affiliation: University of Washington, Seattle.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Bulger
authors.affiliation: University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Mourtzakis
authors.affiliation: Queen's University at Kingston, Kingston, Ontario, Canada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D002149:Energy Intake; D004750:Enteral Nutrition; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D009752:Nutritional Status; D015995:Prevalence; D012121:Respiration, Artificial; D012737:Sex Factors; D014947:Wounds and Injuries / Q000150:complications / Q000378:metabolism / Q000628:therapy
keywords: critical injury; enteral feeding; nutrition adequacy