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EBP Compendium: Summary of Systematic Review

The Cochrane Collaboration
Nutritional Support for Head-Injured Patients

Perel, P., Yanagawa, T., et al. (2006).
Cochrane Database of Systematic Reviews(4).

Indicators of Review Quality:

The review addresses a clearly focused question No
Criteria for inclusion of studies are provided Yes
Search strategy is described in sufficient detail for replication Yes
Included studies are assessed for study quality Yes
Quality assessments are reproducible Yes

Description: This is a systematic review of randomized controlled trials which address the type of delivery of nutritional support as well as timing of nutritional support for individuals with traumatic brain injury (TBI). The findings suggest that early feeding may be associated with fewer infections and better outcomes for survival and disability. Furhter research is warranted.

Question(s) Addressed:

Question not specifically stated.

Population: Participants with acute traumatic brain injury, including all ages and all severity levels.


Comparisons of:

  • Early vs. delayed nutritional support
  • Parenteral vs. enteral nutritional support
  • Gastric vs. jejunal enteral nutrition

Number of Studies Included: 11

Years Included: Initial cut-off not stated. Last search update conducted July 2006.



The timing of nutritional support is influenced by the type of feeding used. Perenteral nutrition was generally initiated between 24 and 72 hours of the injury. Enteral feeding was typically started much later. The reduced methodological quality of the study limits the conclusions which can be drawn, however, there was a trend towards increased survival and reduced disability with early nutritional support.

Keywords: Brain Injury, Tube Feeding

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The information in this systematic review is indirectly related to the field of speech-language pathology, as SLPs are not directly involved in the placement of nutritional support. However, the information included in this review is of interest to SLPs involved in the care of head injured patients as the SLP may play a consultative role on nutritional management. 

Added to Compendium: February 2012

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