title: Nutrition therapy in the optimisation of health outcomes in adult patients with moderate to severe traumatic brain injury: findings from a scoping review.
abstract: BACKGROUND
  Patients who have sustained traumatic brain injury (TBI) have increased nutritional requirements yet are often unable to eat normally, and adequate nutritional therapy is needed to optimise recovery. The aim of the current scoping review was to describe the existing evidence for improved outcomes with optimal nutrition therapy in adult patients with moderate to severe TBI, and to identify gaps in the literature to inform future research.
  
  
  METHODS
  Using an exploratory scoping study approach, Medline, Cinahl, Embase, CENTRAL, the Neurotrauma reviews in the Global Evidence Mapping (GEM) Initiative, and Evidence Reviews in Acquired Brain Injury (ERABI) were searched from 2003 to 14 November 2013 using variations of the search terms 'traumatic brain injury' and 'nutrition'. Articles were included if they reported mortality, morbidity, or length of stay outcomes, and were classified according to the nature of nutrition intervention and study design.
  
  
  RESULTS
  Twenty relevant articles were identified of which: 12 were original research articles; two were systematic reviews; one a meta-analysis; and five were narrative reviews. Of these, eleven explored timing of feed provision, eight explored route of administration of feeding, nine examined the provision of specific nutrients, and none examined feeding environment. Some explored more than one intervention. Three sets of guidelines which contain feeding recommendations were also identified.
  
  
  CONCLUSIONS
  Inconsistency within nutrition intervention methods and outcome measures means that the present evidence base is inadequate for the construction of best practice guidelines for nutrition and TBI. Further research is necessary to elucidate the optimal nutrition therapy for adults with TBI with respect to the timing, route of administration, nutrient provision and feeding environment. A consensus on the ideal outcome measure and the most appropriate method and timing of its measurement is required as a foundation for this evidence base.
authors.affiliation: Nutrition and Dietetics, Faculty of Health, The University of Canberra, Bruce, Australian Capital Territory 2601, Australia; Discipline of Acute Care Medicine, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia 5000, Australia. Electronic address: lee-anne.costello@adelaide.edu.au.
authors.forename: Lee-Anne S
authors.initials: LA
authors.lastname: Costello
authors.affiliation: Nutrition and Dietetics, Faculty of Health, The University of Canberra, Bruce, Australian Capital Territory 2601, Australia.
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Lithander
authors.affiliation: National Trauma Research Institute, The Alfred Hospital and Monash University, Melbourne, Victoria 3004, Australia.
authors.forename: Russell L
authors.initials: RL
authors.lastname: Gruen
authors.affiliation: Nutrition and Dietetics, Faculty of Health, The University of Canberra, Bruce, Australian Capital Territory 2601, Australia; Nutrition and Dietetics, Faculty of Health, Griffith University, Southport, Queensland 4217, Australia.
authors.forename: Lauren T
authors.initials: LT
authors.lastname: Williams
mesh_terms: D001930:Brain Injuries / Q000150:complications / Q000628:therapy*; D006801:Humans; D044623:Nutrition Therapy / Q000295:instrumentation / Q000379:methods; D017410:Practice Guidelines as Topic; D011379:Prognosis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Brain injury; Nutrition intervention; Trauma