Early enteral nutrition compared to outcome in critically ill trauma patients at a level one trauma centre

  • Emilia Löfgren Karolinska Institute
  • Tobela Mabesa Inkosi Albert Luthuli Central Hospital
  • Folke Hammarqvist Karolinska Institute
  • Timothy Craig Hardcastle Inkosi Albert Luthuli Central Hospital and University of KwaZulu-Natal
Keywords: enteral nutrition, early initiation, outcome prediction

Abstract

Objectives: The benefit of an early enteral nutrition start in critical ill patients is widely accepted. However, limited published data focus on trauma patients. This study aimed to investigate the effect of early enteral nutrition initiation on length of stay and mortality in an intensive care unit (ICU), as well as explore if enteral nutrition initiation could serve as a prognostic marker in trauma patients. Design: This was a retrospective audit of a prospective ethics-approved database (University of KwaZulu-Natal Biomedical Research Ethics Committee No BE207-09) which compared enteral nutrition to outcome. Setting: The setting was a level 1 trauma ICU in Durban, South Africa. Subjects: The subjects were critically ill trauma patients. Outcome measures: Demographic data, enteral nutrition timing, feed tolerance, and the outcome of early versus late initiation of enteral feeding were the outcome measures. Results: Nine hundred and fifty-two patients were included. Eight hundred and ninety-eight received enteral nutrition and were divided into three subgroups (tertiles T1-T3) according to their Injury Severity Score (ISS). The statistical analysis demonstrated that an early enteral nutrition start had a significant positive effect on both length of stay (13.7 vs. 16.4 days, p-value 0.00315) and mortality (9.5 % vs. 20.7 % p-value 0.0062). A multiple logistic regression model was developed, using multiple variables, to test the factors that affected the outcome. There was a significant effect on length of stay with an early enteral nutrition start in patients with a low to medium ISS (T1), and a highly significant effect on mortality in patients with a low to medium, and high, ISS (T1 and T2). Early initiation of enteral nutrition is strongly favoured in regression analyses. Conclusion: Patients in the trauma ICU benefit from an early enteral nutrition. The model used featuring the three independent variables, i.e. the day on which enteral nutrition is commenced, age and ISS, may serve as a prognostic marker with regard to length of stay and mortality in the ICU.

Author Biographies

Emilia Löfgren, Karolinska Institute
MD Medical Student - research toward MD degree Clintec Karolinska Institute Stockholm Sweden
Tobela Mabesa, Inkosi Albert Luthuli Central Hospital
RD(SA) Senior Dietician Inkosi Albert Luthuli Central Hospital
Folke Hammarqvist, Karolinska Institute
MC, PhD Professor Clintec Karolinska Institute Stockholm Sweden
Timothy Craig Hardcastle, Inkosi Albert Luthuli Central Hospital and University of KwaZulu-Natal
MBChB, MMed(Chir), FCS(SA), Trauma (HPCSA), PhD Head: Clinical Unit: Trauma and Trauma-ICU Inkosi Albert Luthuli Central Hospital; and Honorary Lecturer Department of Surgery University of KwaZulu-Natal
Published
2015-02-01
How to Cite
Löfgren, E., Mabesa, T., Hammarqvist, F., & Hardcastle, T. (2015). Early enteral nutrition compared to outcome in critically ill trauma patients at a level one trauma centre. South African Journal of Clinical Nutrition, 28(2), 70-76. Retrieved from http://sajcn.redbricklibrary.com/index.php/SAJCN/article/view/922
Section
Original Research