Impact of nutrient intake (enteral or oral diet) on nutrition status in stroke patients admitted to the Neuroscience Intensive Care Unit (NSICU) and disposition at discharge

There are no specific nutrition guidelines for acute stroke patients. The purpose of this study was to analyze nutrition interventions in acute stroke patients and determine what produces the best patient outcomes. One-hundred and forty-one patients admitted to the NSICU with stroke at Rush University Medical Center (RUMC) between 2009-2010 were eligible for this study. Relationships between percent prescribed calories and feeding modalities, discharge disposition, level of independence, length of stay, stroke classification, Glasgow Coma Score, and infectious complications (pneumonia, blood stream infection, urinary tract infection). Stroke patients had inadequate energy and protein intake with an average of 38% of calorie needs and 46% of protein needs met. Subjects who received solely tube feeding had a significantly higher percentage of calorie needs met compared to patients on an oral diet or an oral diet and tube feeding (p<0.005). However, in further analysis patients received a significantly higher percentage of calorie (p=0.035) and protein (p=0.036) needs when all of their meals were recorded by nursing than patients who did not have all meals recorded and they also received significantly more protein than those only on tube feeding (p<0.047). Patients requiring modified dependence or moderate assistance, significantly consumed less than 50% of their prescribed calories compared to those that were completely dependent or required total assistance and those that were completely independent or required no assistance (p=0.03). Patients that had met 50% or more of prescribed calories had a longer hospital stay (17.85±11.43 days) and ICU stay (14.21±9.11 days) than those that met less than 50% of prescribed calorie needs (10.21±7.21 days and 7.17±6.94 days respectively) (p<0.0001). Patients who were discharged home had a significantly higher GCS on admission than those who had expired or changed to hospice care (p<0.0001). In conclusion, patients in the NSICU at RUMC are not meeting calorie or protein needs as determined by the dietitian. Patients who received tube feeding-only, although meeting more of their prescribed calories, were mostly discharged to a rehabilitation center or skilled nursing facility while patients on oral diets were mostly discharged home. Collaborative efforts with nursing and dietitians need to be completed to document oral intake and provide appropriate nutrition therapies to those requiring assistance with meals.