Enteral nutrition for patients with traumatic brain injury in the rehabilitation setting: Associations with patient preinjury and injury characteristics and outcomes

Objective To determine the association of enteral nutrition (EN) with patient preinjury and injury characteristics and outcomes for patients receiving inpatient rehabilitation after traumatic brain injury (TBI). Design Prospective observational study. Setting Nine rehabilitation centers. Participants Patients (N=1701) admitted for first full inpatient rehabilitation after TBI. Interventions Not applicable. Main Outcome Measures FIM at rehabilitation discharge, length of stay, weight loss, and various infections. Results There were many significant differences in preinjury and injury characteristics between patients who received EN and patients who did not. After matching patients with a propensity score of >40% for the likely use of EN, patients receiving EN with either a standard or a high-protein formula (>20% of calories coming from protein) for >25% of their rehabilitation stay had higher FIM motor and cognitive scores at rehabilitation discharge and less weight loss than did patients with similar characteristics not receiving EN. Conclusions For patients receiving inpatient rehabilitation after TBI and matched on a propensity score of >40% for the likely use of EN, clinicians should strongly consider, when possible, EN for ≥25% of the rehabilitation stay and especially with a formula that contains at least 20% protein rather than a standard formula.