Find A Physician

Return to After a Severe Head Injury, Early Nutrition Critical to Survival, Study Shows Overview

More on After a Severe Head Injury, Early Nutrition Critical to Survival, Study Shows

Research and Clinical Trials

Return to After a Severe Head Injury, Early Nutrition Critical to Survival, Study Shows Overview

More on After a Severe Head Injury, Early Nutrition Critical to Survival, Study Shows

After a Severe Head Injury, Early Nutrition Critical to Survival, Study Shows

New York (Jun 15, 2009)

Sign on ICU door

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.

quote from article

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.

Brain in Overdrive

Imaging studies have shown that a severe traumatic injury sends the brain into a "hypermetabolic state," said Dr. Härtl, in which everything is running full speed. At the same time, "the mitochondria, the power stations in brain cells that metabolize glucose, are not functioning properly." Doctors believe these factors together explain why the brain develops a disproportional increase in energy requirements after a severe injury.

Roger Hartl, M.D
Roger Härtl, M.D.
(photo: Weill Cornell
Medical College)

The information gathered for the guideline compliance study only told whether patients were still alive two weeks after their injury – but gave no indication of how well they recovered. But, said Dr. Härtl, previous studies have shown that any steps taken to decrease death rates, such as lowering pressure inside the skull and managing blood pressure, also improve patients' outcome. "We're not just shifting the patients who would have died into a vegetative state, but actually really increasing overall the quality of survival," he said.


Choice of Hospital Crucial

The database held another surprise, Dr. Härtl said, namely just how critical it is to get patients to a level 1 trauma center for treatment. "If TBI patients were not brought directly to a level 1 trauma center, but were brought to a community hospital first and to a trauma center later, they tended to have a poorer outcome." Level 1 trauma centers provide better care for patients with a traumatic brain injury, he said, because neurosurgeons are available around the clock, there's a functional CT scanner around the clock, a fully-trained trauma team, and a trauma bay with all the necessary equipment ready to go. "Patients are immediately greeted by the trauma team when they arrive," he said.

Roger Härtl, MD is an Attending Neurological Surgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and the Chief of Spinal Surgery at Weill Cornell Medical College.

  • Bookmark
  • Print

    Find a Doctor

Click the button above or call
1 877 NYP WELL


eNewsletters




Top of page