Prevalence, risk factors, and clinical consequence of enteral feeding intolerance in elderly patients with traumatic brain injury: a two-center study

Enteral nutrition (EN) support is important for patients with traumatic brain injury (TBI). Enteral feeding intolerance (EFI) is common among critically ill patients and may lead to inadequate EN support. Currently, TBI in elderly individuals poses a growing health concern. The aim of this study was to investigate the prevalence, risk factors, and clinical consequences of EFI in elderly patients with TBI.

We performed a two-center retrospective analysis. Elderly patients (>59 years old) with TBI admitted from January 2022 to December 2024 were included. A total of 934 patients were screened, and 159 were finally analyzed.

The overall prevalence of EFI was 44.0%. High gastric residual volume (42.9%) and diarrhea (41.4%) were the two most common direct causes of EFI. Age, blood transfusion and ventilation duration were independent risk factors for EFI. Patients with EFI were more likely to receive inadequate EN support (adjusted odds ratio 3.84, 95% CI: 1.39-10.63) and had higher in-hospital mortality (adjusted hazard ratio 2.76, 95% CI: 1.16-6.56), as well as lower Glasgow Outcome Scale (GOS) scores at discharge (adjusted odds ratio 0.49, 95% CI: 0.25-0.96).

EFI is common in elderly patients with TBI, and the risk increases with age. Blood transfusion and prolonged ventilation duration are independent risk factors for EFI, in addition to age. EFI episodes are associated with inadequate nutrition support and worse clinical outcomes. Interventions to manage EFI may benefit elderly patients with TBI.