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Effect of Early Nutritional Support on Intensive Care Unit Length of Stay and Neurological Status at Discharge in Children With Severe Traumatic Brain Injury

Taha, Asma A.; Badr, Lina; Westlake, Cheryl; Dee, Vivien; Mudit, Mathur; Tiras, Kathyrne L.

Journal of Neuroscience Nursing: December 2011 - Volume 43 - Issue 6 - p 291–297
doi: 10.1097/JNN.0b013e318234e9b2

ABSTRACT Pediatric severe traumatic brain injury treatment guidelines for nutrition indicate that “there are insufficient data to support a treatment guideline for this topic” (P. D. Adelson et al., 2003). Based on adult studies, the guideline provided an option for practitioners to start nutritional support within 72 hours of admission and full replacement by day 7. This retrospective, descriptive correlation study examined the timing of nutritional supplement initiation and the timing of achieving full caloric intake in relation to length of stay (LOS) in the intensive care unit (ICU) and patient disposition status at discharge from hospital in children 8–18 years old. Median time to initiation of nutrition was 1.5 days (0.02–11.9 days), and full caloric goals were achieved in 3.4 days (0.5–19.6 days). Median ICU LOS was 2.1 days (0.01–97.9 days). Overall, 48% of patients were discharged home; 28% experienced mild, moderate, or severe disability; and 24% either died or survived in a vegetative state. Early initiation and achieving full caloric intake were both positively correlated with shorter LOS in the ICU (p < .01, Spearman’s rho correlational matrix) and better disposition status at discharge from the hospital (p < .05, Kruskal–Wallis test).

Questions or comments about this article may be directed to Asma A. Taha, PhD RN CPNP CNS CCRN, at She is an assistant professor at California State University San Bernardino and a pediatric neurosurgery nurse practitioner at Loma Linda University Medical Center, Loma Linda, CA.

Lina Badr, DNSc RN PNP, is a professor of the MSN program and director of the PNP Program at Azusa Pacific University. Azusa, CA.

Cheryl Westlake, PhD RN ACNS-BC, is a professor and associate dean of the International and Community Programs and Nursing PhD Program, Azusa Pacific University, Azusa, CA.

Vivien Dee, DNSc MN CNAA BC FAAN, is a professor of the PhD Program at Azusa Pacific University, Azusa, CA.

Mathur Mudit, MD, is an assistant professor in the Division of Pediatric Critical Care Medicine at Loma Linda University, Loma Linda, CA.

Kathyrne L. Tiras, RN MSN CNS, is a lecturer at California State San Bernardino and a staff nurse at Loma Linda University Medical Center, Loma Linda, CA.

The authors report no actual or potential conflicts of interest.

This work was funded by a Doctoral Dissertation Grant–Nursing PhD Program, Azusa Pacific University.

© 2011 American Association of Neuroscience Nurses