A structured clinical nutrition pathway for enteral nutrition management in patients with intracerebral hemorrhage: a non-randomized controlled study.

OBJECTIVE

To examine whether a SAPIM-based structured clinical nutrition pathway, operationalized in this study as systematic assessment, personalized intervention, and multidisciplinary management, was associated with improved enteral nutrition management and short-term clinical outcomes in patients with intracerebral hemorrhage (ICH).

METHODS

This non-randomized controlled study was conducted in a tertiary hospital in China between January and June 2025. A total of 60 patients with hypertensive intracerebral hemorrhage who required enteral nutrition were included. Patients in the intervention group received care under the SAPIM-based clinical nutrition pathway, while those in the control group received routine nutritional care. The primary outcome was the occurrence of enteral nutrition-related complications during hospitalization. Secondary outcomes included nutritional indicators (NRS-2002, prealbumin, albumin, total protein, and hemoglobin), functional outcomes (ADL, NIHSS, and aspiration risk score), patient satisfaction, and length of hospital stay.

RESULTS

Compared with the routine care group, the SAPIM group had a lower rate of enteral nutrition-related complications (30.0% vs. 56.7%, p = 0.037). Patients managed under the SAPIM pathway showed more favorable nutritional and functional trajectories during hospitalization, and their hospital stay was shorter than that of the control group (15.5 ± 4.9 vs. 23.4 ± 8.5 days, p < 0.0001). In exploratory logistic regression analyses, SAPIM implementation was associated with a lower risk of enteral nutrition-related complications in the unadjusted model and remained consistent in the primary adjusted and BMI-adjusted sensitivity models.

CONCLUSION

The SAPIM-based clinical nutrition pathway was associated with safer and more consistent enteral nutrition management and more favorable short-term clinical profiles in patients with intracerebral hemorrhage. This structured approach may be a practical option for improving nutritional care in neurocritical settings.