Nutrition critical after severe brain injury

NEW YORK (Reuters Health) - Adequate nutrition within the first couple of days after severe traumatic brain injury improves patient survival, according to researchers from New York's Weill Cornell Medical College.

After a severe traumatic brain injury the metabolism speeds up, which increases the amount of calories required by the body and the brain, co-author Dr. Roger Hartl and colleagues point out. They note that current practice guidelines from the Brain Trauma Foundation recommend only that "the patient's feeding requirements should be met by the end of the first week after severe traumatic brain injury."

By reviewing data on 797 adults with severe traumatic brain injury who survived for at least 1 week, the researchers looked at the effect of the timing and quantity of nutrition on death within the first 2 weeks of injury. The patients were treated at 22 trauma centers in New York between 2000 and 2006. The study findings appear in the Journal of Neurosurgery.

After accounting for the effects of low blood pressure, age, diagnosis according to CT imaging, coma score, and pupil status, the authors found that nutrition provided soon after the injury was an independent predictor of survival. Waiting 5 days to start nutrition doubled the risk of death at 2 weeks - and waiting 7 days quadrupled the risk.

The amount of nutritional support was also important; every 10 kcal/kg decrease in calories in the first 5 days after the injury was associated with a 30 percent to 40 percent increase in mortality.

Along with preventing a drop in blood pressure and oxygen, and a build-up of blood pressure in the skull, early nutritional support is one of the few interventions that can directly affect the outcome of patients with severe traumatic brain injuries, the investigators conclude.

In a statement from Cornell Weill Medical College, Hartl adds that the Brain Trauma Foundation will be revising its nutritional guidelines in light of these new findings.

SOURCE: Journal of Neurosurgery, July 2008.