Penn State equation versus indirect calorimetry for nutritional assessment in patients with traumatic brain injury
Sonia Wu1, Sameena Iqbal1, Melanie Giroux1
1From the Faculty of Medicine, McGill University, Montréal, Que. (Wu, Iqbal, Razek, Deckelbaum, Grushka, McKendy, Wong, Marcoux, Khwaja); the Division of Nephrology, McGill University Health Centre, Montréal, Que. (Iqbal); the Department of Respiratory Therapy, McGill University Health Centre, Montréal, Que. (Giroux); the Department of Critical Care Medicine, McGill University Health Centre, Montréal, Que. (Alam, Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Division of General and Trauma Surgery, McGill University Health Centre, Montréal, Que. (Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Department of Neurology and Neurosurgery, McGill University Health Centre, Montréal, Que. (Marcoux); and the Research Institute, McGill University Health Centre, Montréal, Que. (Campisi).
Background:
Nutritional assessment can be challenging in patients with traumatic brain injury (TBI), and indirect calorimetry may be a more suitable method than predictive equations. We compared the Penn State equation versus the gold standard of indirect calorimetry for the nutritional assessment of patients with TBI, and quantified the difference between nutritional requirements and actual patient intake.
Methods:
This single-centre, prospective cohort study included patients with moderate (Glasgow Coma Scale score 9-12) and severe (Glasgow Coma Scale score 3-8) TBI admitted to the Montreal General Hospital intensive care unit (ICU) between June 2018 and March 2019. Penn State equation estimates and indirect calorimetry measurements were collected, and actual intake was drawn from medical records. We compared the 2 assessment methods using a Spearman correlation coefficient.
Results:
Twenty-three patients with TBI (moderate in 7 and severe in 16) were included in the study. Overall, there was a moderate positive correlation between the Penn State equation estimate and indirect calorimetry readings (correlation coefficient 0.457, p = 0.03); however, the correlation was weaker in severe TBI (correlation coefficient 0.174, p = 0.5) than in moderate TBI (correlation coefficient 0.929, p = 0.003). When compared to indirect calorimetry assessment, patients received 5.4% (p = 0.5) of required intake on the first day and 43.9% (p = 0.8) of required daily intake throughout their ICU stay.
Conclusion:
Patients with moderate or severe TBI in the ICU received less than 50% of their nutritional requirements. The difference between the Penn State equation and indirect calorimetry assessments was most noticeable for patients with severe TBI, which indicates that indirect calorimetry may be a more suitable tool for assessment of nutritional needs in this population.
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