Guideline/Step of Care Process with Nutrition Implications

Brain Trauma Foundation (BTF)

Guidelines for the Management of Severe Traumatic Brain Injurya

American Society for Parenteral and Enteral Nutrition Critically Ill Patientb



(NOT including renal pancreatitis and end of life)

a Bratton et al., 2007.

b McClave et al., 2009.

c ADA, 2006.

d Mcilvoy and Meyer, 2008.

TABLE B-2 Summary Table for Nutrition Content of Existing EBGs for Non-ICU Acute TBI

Guideline/Care Process

Guidelines for the Field Management of Combat-Related Head Traumaa

Mild TBI-Acute Nondeployed Care; Mild TBI Sub-Acute

Interdisciplinary team (referrals to PT, OT, Speech & Language pathology, pharmacy, audiology/vestibular and optometry)

VA Management of Concussion/Mild Traumatic Brain Injuryb

(Adults, nonacute, not management of moderate or severe TBI)

Nutrition-related assessment information

Neurobehavioral Symptom Inventory (includes nausea, change in appetite, taste or smell)

Patient Health Questionnaire (includes changes in appetite)

Sub-Acute Cognitions (normalize nutrition)

BMI > 30 (Refer for Sleep Study)

Nausea, vomiting

Change in appetite

Change in taste or smell

Specific nutrition interventions

Novel therapy (nutritional supplements)

Limit caffeine and alcohol.

Minimize caffeine and avoid herbal diet supplements such as “energy” products as some contain agents that cross-react with psychiatric mediation and lead to a hypertensive crisis.

Novel therapy (hyperbaric oxygen, nutritional supplements) modalities in the management of concussion/mTBI are being explored in the field as potential treatment approaches. It is the recommendation of the Working Group that interventions that lack sufficient empirical support should occur only under the auspices of an IRB-reviewed protocol.

Monitoring and evaluations of nutrition-related indicators



aKnuth, 2005.

bDepartment of Veterans Affairs and Department of Defense (VA/DoD), 2009.

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