Development of a nutritional management protocol for patients with severe traumatic brain injury: a Delphi study

Patients with severe traumatic brain injury (sTBI) commonly experience hypermetabolism, catabolism, and feeding intolerance, making nutritional management an essential part of clinical care. However, there is still a lack of standardized and integrated protocols to guide nutritional management in this population.

To develop an evidence-based nutrition management protocol for patients with sTBI.

An evidence-based approach was adopted to formulate the protocol. Relevant evidence was identified through systematic retrieval, followed by quality appraisal, evidence synthesis, and grading. A preliminary protocol was then developed and further revised through two rounds of Delphi expert consultation. Experts rated each item in terms of feasibility and importance.

A total of 17 studies were included after evidence retrieval and appraisal and the preliminary protocol consisting of 5 primary indicators, 10 secondary indicators, and 33 tertiary indicators was developed. This preliminary protocol was then refined through two rounds of Delphi expert consultation involving 15 experts. The Kendall's harmony coefficients for item feasibility were 0.399 and 0.331, respectively, and those for item importance were 0.288 and 0.465, respectively. The final protocol included 4 primary indicators, 11 secondary indicators and 33 tertiary indicators.

This study developed an evidence-based nutritional management protocol for patients with sTBI. The protocol provides an evidence-informed framework to support standardized nutritional management in patients with sTBI.