Acute Traumatic Brain Research Articles

Nutritional support for head-injured patients

Head injury increases the body's metabolic responses, and therefore nutritional demands. Provision of an adequate supply of nutrients is associated with improved outcome. The best route for administering nutrition (parenterally (TPN) or enterally (EN)), and the best timing of administration (for example, early versus late) of nutrients needs to be established. To quantify the effect on mortality and morbidity of alternative strategies of providing nutritional support following head injury. Trials were identified by computerised searches of the Cochrane Injuries Group specialised register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, National Research Register, Web of Science and other electronic trials registers. Reference lists of trials and review articles were checked. The searches were last updated in July 2006. Randomised controlled trials of timing or route of nutritional support following acute traumatic brain injury. Two authors independently abstracted data and assessed trial quality. Information was collected on death, disability, and incidence of infection. If trial quality was unclear, or if there were missing outcome data, trialists were contacted in an attempt to get further information. A total of 11 trials were included. Seven trials addressed the timing of support (early versus delayed), data on mortality were obtained for all seven trials (284 participants). The relative risk (RR) for death with early nutritional support was 0.67 (95% CI 0.41 to 1.07). Data on disability were available for three trials. The RR for death or disability at the end of follow-up was 0.75 (95% CI 0.50 to 1.11). Seven trials compared parenteral versus enteral nutrition. Because early support often involves parenteral nutrition, three of the trials are also included in the previous analyses. Five trials (207 participants) reported mortality. The RR for mortality at the end of follow-up period was 0.66 (0.41 to 1.07). Two trials provided data on death and disability. The RR was 0.69 (95% Cl 0.40 to 1.19). One trial compared gastric versus jejunal enteral nutrition, there were no deaths and the RR was not estimable. This review suggests that early feeding may be associated with a trend towards better outcomes in terms of survival and disability. Further trials are required. These trials should report not only nutritional outcomes but also the effect on death and disability.

Treatment of Critical Care Patients with Substantial Acute Ischemic or Traumatic Brain Injury

Treatment of Critical Care Patients with Substantial Acute Ischemic or Traumatic Brain Injury

Trismus after stroke/TBI: Botulinum toxin benefit and use pre-PEG placement

Oropharyngeal dysphagia can occur in patients with cerebral damage of different etiologies such as acute stroke and traumatic brain injury (TBI).1,2 The incidence may be as high as 50% in stroke1 and 61% in TBI.2 Dysphagia compromises both nutrition and hydration and can cause severe complications such as aspiration pneumonia and dehydration. Considering these risks, patients with severe dysphagia are often fed by percutaneous endoscopic gastrostomy (PEG) or nasogastric tubes. PEG is the treatment of choice for persistent dysphagia due to neurologic diseases as it is better tolerated and more acceptable than the nasogastric tube to both patients and caregivers.3 However, PEG placement can be very difficult or even impossible to perform in patients unable to open their mouth owing to spastic closure secondary to neurologic diseases. In these patients, spastic overactivation of masseter muscles can make the manual procedures to passively open the mouth unsuccessful, painful, and dangerous. …

Effects of alcohol use on neuropsychological test performance in acute care mild traumatic brain injured population

Effects of alcohol use on neuropsychological test performance in acute care mild traumatic brain injured population

Prediction of recovery of continuous memory after traumatic brain injury.

To evaluate the ability of measures of initial severity, tests of attention, and demographic characteristics to predict recovery of continuous memory for words over a 24-hour period in patients with acute traumatic brain injury. Recovery of continuous memory was assessed prospectively in 94 patients with nonpenetrating traumatic brain injury. A classification and regression tree analysis identified a hierarchical subset of variables that may be used as a simple guideline for predicting recovery of continuous memory. Weibull regression models evaluated and compared the predictive ability of multiple variables. Four groups of patients were identified based on measures of severity of injury and demographic characteristics. These four groups had recovery profiles that were more precise than could be obtained by using the Glasgow Coma Scale alone: mild, about 1 week to recovery of continuous memory; moderate, 1 to 4 weeks; severe, 2 to 6 weeks; and extremely severe, 4 to 8 weeks. Regression analysis confirmed that measures of capacity (inherent resources such as indicated by age) and compromise (general functional brain state measured neuropsychologically) improved prediction over models based only on injury severity measures, such as the Glasgow Coma Scale. Approaches to predicting recovery of continuous memory in the acute period after traumatic brain injury that take into account multiple measures provide a more sensitive predictive index.

Neuropsychological impairments in acute versus nonacute mild traumatic brain injury

Neuropsychological impairments in acute versus nonacute mild traumatic brain injury