Nutritional Assessment Tools, Prognostic Factors, and Outcomes in Critically Ill Geriatric Trauma Patients: A Systematic Review.

INTRODUCTION

This systematic review aims to comprehensively evaluate malnutrition risk assessment, nutritional status assessment, prognostic factors, and nutrition components in critically ill geriatric trauma patients.

METHODS

Five databases were queried, including PubMed, Google Scholar, ProQuest, Embase, and Cochrane. Included studies evaluated nutritional status assessment tools, prognostic factors, and nutritional components or quantity measures. Outcomes of interest include mortality, intensive care unit length of stay (LOS), and complications.

RESULTS

The geriatric nutritional risk index was a significant predictor of mortality (all P < 0.05), hospital LOS (26.5 versus 20.9 d; P = 0.012), and complications including sepsis (13% versus 1%; P < 0.001) and pneumonia (8% versus 2%; P = 0.008). The Mini Nutritional Assessment and Short Nutritional Assessment Questionnaire were found to predict cognitive decline (P = 0.004), delirium (odds ratio = 2.0; 95% confidence interval: 1.01-4.35), and hospital-acquired infections (P = 0.009). Albumin was found to predict both mortality and intensive care unit LOS, while advanced age, more critical injuries, and comorbidities such as congestive heart failure and end-stage renal and liver disease were associated with increased mortality. Nutritional composition requires high protein (> 2 g/kg/d), lower exogenous carbohydrates (< 18 kcal/kg/d), and energy requirements determined by indirect calorimetry (IC) or the American Society for Parenteral and Enteral Nutrition-Society of Critical Care Medicine equation if IC is unavailable.

CONCLUSIONS

Effective nutritional management of critically ill geriatric trauma patients includes the geriatric nutritional risk index for nutritional assessment supplemented with continuous monitoring for negative prognostic factors. Lastly, nutritional composition requires high protein, lower exogenous carbohydrates, and energy requirements determined by IC or the American Society for Parenteral and Enteral Nutrition-Society of Critical Care Medicine equation if IC is unavailable.