Efficacy of early enteral nutrition in patients with traumatic brain injury: a systematic review and meta-analysis.
Early enteral nutrition linked to lower short-term mortality in trials of traumatic brain injury
Efficacy of early enteral nutrition in patients with traumatic brain injury: a systematic review and meta-analysis.
Severe traumatic brain injury (traumatic brain injury) induces a hypermetabolic state that heightens the risk of mortality and poor neurological outcomes.
Following PRISMA guidelines, we systematically searched the PubMed, Embase, Web of Science, and Cochrane Library databases through December 25, 2025, for studies comparing enteral nutrition with delayed enteral nutrition (delayed enteral nutrition) in adults with traumatic brain injury.
trials found early feeding cut short-term deaths in traumatic brain injury
When all studies (RCTs and observational) were pooled, there was no significant difference in short-term mortality risk between enteral nutrition and delayed enteral nutrition (risk ratio [RR] = 0.64; 95% CI, 0.32-1.31).
Enteral nutrition significantly shortened mechanical ventilation duration and reduced both ICU and hospital length of stay.
Enteral nutrition also significantly lowered rates of sepsis, central nervous system infection, stress ulcer, ventilator-associated pneumonia, and total adverse events (all p values range from <0.00001 to 0.04), though it was associated with a mildly elevated risk of diarrhea ( p = 0.02).
In this meta-analysis, enteral nutrition initiated within 48 h of traumatic brain injury showed a trend toward reduced short-term mortality and improvements in clinical and nutritional outcomes compared to delayed enteral nutrition.
However, these findings should be interpreted cautiously given the high risk of bias and substantial statistical heterogeneity in the included studies.
Future high-quality, large-scale RCTs are needed to confirm these effects and refine optimal feeding strategies in this population.