How is nutrition related to head injury recovery?

The moment a patient with a severe head injury is wheeled into the emergency room of a trauma center, doctors rush to provide life-saving measures. They begin monitoring pressure inside the skull and, if necessary, operate to lower it. They treat low blood pressure, make sure oxygen levels in the blood are sufficient, and medicate to prevent seizures. These procedures are all spelled out in a set of "best practice" guidelines established in 1995, which have helped dramatically lower death rates from traumatic brain injury (TBI), said NewYork-Presbyterian neurosurgeon Roger Härtl, MD.

A recent study by Dr. Härtl and colleagues showed that another measure, which had always been something of an afterthought, was also of vital importance: ensuring that patients receive nutrients in the first few days following their injury.

Dr. Härtl and his colleagues discovered the significance of early nutrition almost by accident. They were analyzing data from a six-year study of how well New York State trauma centers were complying with the TBI guidelines when this finding leapt out: "We found almost a linear relationship between nutrition and mortality," Dr. Härtl said. In other words, patients who did not receive food – commonly through a tube inserted in their stomachs – within the first five days of their brain injury were twice as likely to die, and those who did not receive feeding within seven days were four times as likely to die.

The study also made clear that, not only is it better to get nutrients into patients as early as possible, but also that the more nutrients they get the better. The best outcomes were in patients who received at least 100 percent of the daily recommended number of calories for someone their weight – but up to 200 percent of that amount was even better, he said.

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