• Hiroyuki Ohbe, Taisuke Jo, Hiroki Matsui, Kiyohide Fushimi, and Hideo Yasunaga.
• Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
• Am. J. Clin. Nutr. 2020 Feb 1; 111 (2): 378-384.

BackgroundWhether enteral nutrition (EN) should be administered early in severe traumatic brain injury (TBI) patients has not been fully addressed.ObjectiveThe present study aimed to evaluate whether early EN can reduce mortality or nosocomial pneumonia among severe TBI patients.MethodsUsing the Japanese Diagnosis Procedure Combination inpatient database from April 2014 to March 2017 linked with the Survey for Medical Institutions, we identified patients admitted for intracranial injury with Japan Coma Scale scores ≥30 (corresponding to Glasgow Coma Scale scores ≤8) at admission. We designated patients who started EN within 2 d of admission as the early EN group, and those who started EN at 3-5 d after admission as the delayed EN group. The primary outcome was in-hospital mortality. The secondary outcome was nosocomial pneumonia. Propensity score-matched analyses were performed to compare the outcomes between the 2 groups.ResultsWe identified 3080 eligible patients during the 36-mo study period, comprising 1100 (36%) in the early EN group and 1980 (64%) in the delayed EN group. After propensity score matching, there was no significant difference in in-hospital mortality (difference: -0.3%; 95% CI: -3.7%, 3.1%) between the 2 groups. The proportion of nosocomial pneumonia was significantly lower in the early EN group than in the delayed EN group (difference: -3.2%; 95% CI: -5.9%, -0.4%).ConclusionsEarly EN may not reduce mortality, but may reduce nosocomial pneumonia in patients with severe TBI.Copyright © The Author(s) 2019.

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