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Early Enteral Nutrition and Clinical Outcomes of Severe Traumatic Brain Injury Patients in Acute Stage: A Multi-Center Cohort Study
Study Question: Does early enteral nutrition (EN) have any impact on 7-day intensive care unit (ICU) survival rate and Glascow coma scale (GCS) score or 1-month post-injury clinical outcomes in patients with severe traumatic brain injury (sTBI)?
Methods: Researchers review medical records were collected from 18 hospitals in Taiwan between January 2002 and May 2010. Eligible patients were those with sTBI and GCS scores between 4 and 8. Patients receiving appropriate calories and nutrients via EN within 48 hours post-injury were matched with patients receiving intravenous fluids only to maintain fluid and electrolyte balance over the first 7 ICU days. Exclusion criteria included a GCS score ≤ 3, receipt of total parenteral nutrition support, and initiation of EN after ICU day 3.
Results: Two hundred ninety-seven patients were included: 145 (48.8%) in the EN group and 152 (51.2%) in the non-EN group. No significant differences in baseline characteristics existed between groups. The percentage of sTBI patients receiving early EN increased significantly from 2002-2006 to 2007-2010. During the first 7 ICU days, the use of early EN was associated with a significantly enhanced survival curve compared to non-EN patients (p < 0.001). Survival rates on day 7 for EN and non-EN patients were 89% and 15.8%, respectively (HR 13.55, 95% CI 8-22.92). GCS scores were also significantly increased among EN patients (p < 0.05). One-month post-injury clinical outcomes, classified into five categories ranging from good recovery to death, were significantly better in EN patients than non-EN patients (p < 0.001). Subgroup analyses based on initial GCS score demonstrated a significantly better survival rate among patients with GCS scores of 6-8 versus 4-5 (p < 0.05).
Conclusions: EN support for sTBI patients within 48 hours post-injury resulted in improved survival and GCS score recovery, particularly among patients with initial GCS scores between 6 and 8.
Perspective: Results from this matched cohort study are consistent with previous studies that have indicated benefits of early EN in sTBI patients. Because patients either received EN within 48 hours post-injury or not at all, no conclusion can be drawn from this study about a correlation between timing of EN (e.g., within 48 h vs. later) and outcomes.
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